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(Stroke. 2006;37:284.)
© 2006 American Heart Association, Inc.

Editorial

Stroke and Encephalopathy After Cardiac Surgery

The Search for the Holy Grail

Sotiris C. Stamou, MD, PhD

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH.

Correspondence and Reprint Requests to Sotiris Stamou, MD, PhD, 27562 Remington Circle, Westlake, OH 44145. E-mail cvsisfun@hotmail.com

Key Words: endarterectomy • stroke • stroke management • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 562–571.

The incidence of clinically obvious strokes after coronary artery bypass graft operations (CABG) is reported to be between 0.8% and 5.2%. It is estimated that between 5000 and 35 000 new strokes develop as a result of this procedure, which possibly makes coronary artery bypass surgery the single largest cause of iatrogenic stroke in the United States.¹ The typically poor postoperative course of patients who develop stroke after cardiac surgery underlines the need for timely recognition, prevention/modification of factors that predispose to stroke. In the present study, McKhann et al² are touching on the mechanisms, risk factors and outcomes of postoperative stroke after cardiac surgery. They also suggest possible algorithms for management of postoperative stroke and ways to prevent the occurrence of stroke after cardiac surgery. Previous authors have identified several preoperative, intraoperative, and postoperative risk factors of stroke after cardiac surgery, such as episodes of hypotension during or after the operation (requiring inotropic support or placement of intra-aortic balloon pump), atrial fibrillation, carotid artery disease, history of cerebrovascular accident, manipulation of aorta and others. Preventive strategies such as routine screening of patients for carotid artery disease with carotid duplex are useful. The application of diffuse-weighted MRI to diagnose silent brain infarcts will be more cost effective if applied to the patients identified as high-risk for postoperative stroke, such as elderly patients, patients with low ejection fraction, atrial fibrillation, diabetes, hypertension, and carotid artery disease. This subset of patients will benefit the most by . . . [Full Text of this Article]

Related Article:

Stroke and Encephalopathy After Cardiac Surgery: An Update

Guy M. McKhann, Maura A. Grega, Louis M. Borowicz, Jr, William A. Baumgartner, and Ola A. Selnes
Stroke 2006 37: 562-571. [Abstract] [Full Text] [PDF]

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