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(Stroke. 2001;32:94.)
© 2001 American Heart Association, Inc.

Original Contributions

Intracranial Cerebral Artery Disease as a Risk Factor for Central Nervous System Complications of Coronary Artery Bypass Graft Surgery

Presented at the 24th American Heart Association International Conference on Stroke and Cerebral Circulation, Nashville, Tenn, February 4–6, 1999.

Byung-Woo Yoon, MD; Hee-Joon Bae, MD; Dong-Wha Kang, MD; Seung-Hoon Lee, MD; Keun-Sik Hong, MD; Ki-Bong Kim, MD; Byung Joo Park, MD, PhD Jae-Kyu Roh, MD

From the Departments of Neurology, Seoul National University (B.W.Y., D.W.K., S.H.L., K.S.H., J.K.R.) and Eulji General Hospital, Eulji University School of Medicine (H.J.B.); the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital (K.B.K.); the Department of Preventive Medicine, Seoul National University College of Medicine (B.J.P.); and Neuroscience Research Institute, SNUMRC and Clinical Research Institute, SNUH (B.W.Y., J.K.R.).

Correspondence to Hee-Joon Bae, MD, Department of Neurology, Eulji General Hospital, 280-1, Hagye 1 Dong, Nowon Gu, Seoul, Korea 139-711. E-mail bhj1405{at}eulji.or.kr

Background and Purpose—Although extracranial carotid artery disease (ECAD) is accepted as a risk factor for central nervous system (CNS) complications after coronary artery bypass graft (CABG) surgery, it remains to be clarified whether intracranial cerebral artery disease (ICAD) may also increase the risk. We conducted a prospective study to elucidate the relation between ICAD and CNS complications after CABG surgery.

Methods—We prospectively studied 201 patients undergoing nonemergency isolated CABG surgery during a 39-month period (from March 1995 to June 1998). Each patient was evaluated before surgery with neurological examination, transcranial Doppler, and carotid duplex ultrasonography. Magnetic resonance angiography was used to determine the presence and severity of ECAD and ICAD in patients with abnormal findings on clinical examination, carotid duplex ultrasonography, or transcranial Doppler. Patients were followed after surgery and evaluated for the development of CNS complications. Association between CNS complications and their potential predictors was analyzed.

Results—One hundred nine patients (54.2%) were found to have ECAD and/or ICAD. ECAD alone was found in 48 patients (23.9%), ICAD alone in 33 (16.4%), and both ECAD and ICAD in 28 (13.9%). Fifty-one patients (25.4%) had single or multiple CNS complications: 23 (11.4%) had delirium; 18 (9.0%) had hypoxic-metabolic encephalopathy; 7 (3.5%) had stroke; and 7 (3.5%) had seizure. In multivariate analysis, ICAD was found to have an independent association with the development of CNS complications (prevalence OR, 2.28; 95% CI, 1.04 to 5.01) after controlling for covariates including age, occurrence of intraoperative events, and reoperation. The joint effect of ECAD and ICAD was also statistically significant and stronger than ICAD alone (prevalence OR, 3.87; 95% CI, 1.80 to 6.52).

Conclusions—Our results suggest that ICAD may be an independent risk factor for CNS complications after CABG surgery. These results support pre-CABG evaluation of the intracranial arteries for the risk assessment of CABG surgery, at least in black and Asian patients, in whom there may be a higher prevalence of intracranial arterial stenosis.

Key Words: bypass surgery • cerebrovascular disorders • risk factors

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