Posterior Distribution of Infarcts in Strokes Related to Cardiac Operations

• Published in: The Annals of thoracic surgery Vol. 65; no. 6; pp. 1656 - 1659
• Main Authors: Barbut, Denise, Grassineau, Dominique, Lis, Eric, Heier, Linda, Hartman, Gregg S, Isom, O.Wayne
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1998; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta - diagnostic imaging; Aorta, Thoracic - diagnostic imaging; Aortic Diseases - diagnostic imaging; Aortic Diseases - etiology; Arteriosclerosis - diagnostic imaging; Arteriosclerosis - etiology; Atrial Fibrillation - etiology; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cerebellum - blood supply; Cerebral Arteries - diagnostic imaging; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebrovascular Circulation; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - etiology; Echocardiography, Transesophageal; Embolism - diagnostic imaging; Embolism - etiology; Female; Humans; Infarction - diagnostic imaging; Infarction - etiology; Intracranial Embolism and Thrombosis - diagnostic imaging; Intracranial Embolism and Thrombosis - etiology; Intraoperative Complications - diagnostic imaging; Male; Medical sciences; Middle Aged; Retrospective Studies; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Time Factors; Tomography, X-Ray Computed; Ventricular Fibrillation - etiology; Heart; Human; Postoperative; Nervous system diseases; Stroke; Radiodiagnosis; Infarct; General anesthesia; Cardiovascular disease; Exploration; Cerebral disorder; Vascular disease; Cardiopulmonary bypass; Treatment; Heart disease; Surgery; Central nervous system disease; Medical imagery; Complication; Early; Computerized axial tomography; Localization; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(98)00272-0

Background. Stroke complicates cardiac surgical procedures in a substantial number of patients. The mechanism of stroke is predominantly embolic, although hypoperfusion may play a role. The aim of this study was to determine whether radiologic appearances in this population were consistent with an embolic cause. Methods. We reviewed computed tomographic scans and medical records in 24 patients who suffered stroke after cardiac operation. Stroke was evident at 24 hours in 19 patients (79%). Infarcts were multiple in 16 and single in 3 patients (group 1). The remaining 5 patients suffered stroke beyond 24 hours and had single infarcts on computed tomographic scan (group 2). Results. In group 1, 15 patients (79%) had bilateral cerebellar infarcts, 4 (74%) had posterior cerebral artery infarcts, 10 (53%) had posterior watershed infarcts, and 11 patients (58%) had middle cerebral artery branch infarcts. The mean number of vascular territories involved was 5.1 (range, 1 to 10). Mobile atheromatous plaque was present in the ascending aorta or arch in 5 of 9 patients (56%) in group 1. In group 2, stroke occurred in close association with atrial or ventricular fibrillation in 3 of 5 patients (60%). Conclusions. In patients with radiologic evidence of infarction, perioperative strokes after cardiac operation are typically multiple, and involve the posterior parts of the brain, consistent with atheroembolization. Delayed strokes may be attributable to cardiogenic embolism.