Thursday, May 28, 2009

Stroke During Coronary Bypass Surgery – an Article Review

My mother died last Tuesday.  She had her coronary bypass surgery just one week before that day.  It was during her CABG that she had her strokes.  Yes, strokes, plural.  She was one of those 1.5% who suffer macroemboli cerebral strokes during coronary bypass surgery. 
I went looking for information on it earlier this week.  I went through my training without ever seeing this complication.  Like everyone, I never thought my family would be the one.  I think it is better to go to surgery, NOT thinking you will be the “statistic” as far as complications go.  Anyone having surgery, SHOULD go into it feeling hopeful and thinking everything will go perfectly.
The article referenced below is a good review of this complication – stroke during coronary bypass surgery. The study is a retrospective review of 6682 consecutive coronary bypass patients who only had the CABG procedure and not other simultaneous procedures, such as carotid endarterectomy.
They list the possible sources of the emboli as the ascending aorta, carotid arteries, intracerebral arteries, or intracardiac cavities.  They state that they believe the most likely source is the ascending aorta, for the following reasons:
First, the ascending aorta is the site of surgical manipulations during CABG, whereas mechanical contact is not made with the other potential sources of emboli.  Embolization of atherosclerotic debris is most likely to occur during aortic  cannulation/decannulation, cross-clamp application/removal, and construction of proximal anastomoses. However, embolization of atherosclerotic debris may also occur when the aorta is not being surgically manipulated, due to the ‘sandblast’ effect of CPB.
Second, the majority of our independent predictors of stroke – elderly age, left ventricular dysfunction, previous stroke/TIA, diabetes, and peripheral vascular disease – are strongly associated with atherosclerosis of the ascending aorta. 
Third, our chart review suggested that the most common probable cause of stroke was atherosclerotic emboli from the ascending aorta. Palpable lesions in the ascending aorta were noted in a large proportion of stroke patients.
The fourth reason we believe the ascending aorta is the likely source of macroemboli is because of ancillary autopsy data. …….

Note the second reason given above – the independent predictors of stroke.  My mother was over 74 yr so fell into the elderly age risk factor group.  She was also a type 2 diabetic.  She was noted to have a small abdominal aneurysm and some renal artery stenosis on the angiogram (an accidental pickup).  So she had three of the four independent risk factors.

Stroke during coronary bypass surgery: principal role of cerebral macroemboli;  Eur J Cardiothorac Surg 2001;19:627-632; Michael A. Borger, Joan Ivanov, Richard D. Weisel, Vivek Rao, Charles M. Peniston


Unknown said...

Hello I am so sorry for your loss, I have just come from the hospital where I have been told that my Grandmother was also in the 1.5% and suffered a massive stroke during her bypass surgery. She is still breathing and her heart is beating but she is not there, she is not 'alive'. Like your mother, at 77 she was also in the elderly bracket but not for one moment did we believe this could happen.
God bless I hope we can both overcome our grief.

rlbates said...

Jules, I am so very sorry to hear about your Grandmother. God bless your family with strength and peace. Take care of one another.

Rhonda said...

Thank you for posting this. I've been searching for answers, as it appears my father has suffered a stroke (or plural) during bypass surgery. He was supposed to have awakened yesterday, but is not responding to verbal or physical stimuli. We are terribly concerned, of course, and don't know what the next days will hold.