Mechanism of stroke complicating cardiopulmonary bypass surgery

J M Rankin, P L Silbert, O P Yadava, G J Hankey, E G Stewart-Wynne

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Abstract

BACKGROUND: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.

AIMS: To determine the incidence, pathology and aetiology of stroke complicating CPB.

METHODS: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.

RESULTS: Twenty-one (1.6%, 95% CI 0.9-2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36-78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22-64%) due to hypoperfusion in a borderzone.

CONCLUSIONS: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.

Original languageEnglish
Pages (from-to)154-60
Number of pages7
JournalAustralian and New Zealand Journal of Medicine
Volume24
Issue number2
Publication statusPublished - Apr 1994

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Cardiopulmonary Bypass
Stroke
Infarction
Incidence
Pathology
Intracranial Embolism
Cerebral Hemorrhage

Cite this

Rankin, J M ; Silbert, P L ; Yadava, O P ; Hankey, G J ; Stewart-Wynne, E G. / Mechanism of stroke complicating cardiopulmonary bypass surgery. In: Australian and New Zealand Journal of Medicine. 1994 ; Vol. 24, No. 2. pp. 154-60.
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abstract = "BACKGROUND: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5{\%} of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.AIMS: To determine the incidence, pathology and aetiology of stroke complicating CPB.METHODS: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.RESULTS: Twenty-one (1.6{\%}, 95{\%} CI 0.9-2.3{\%}) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57{\%}, 95{\%} CI 36-78{\%}) of the cases were felt to be embolic in origin and nine (43{\%}, 95{\%} CI 22-64{\%}) due to hypoperfusion in a borderzone.CONCLUSIONS: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6{\%}. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.",
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Mechanism of stroke complicating cardiopulmonary bypass surgery. / Rankin, J M; Silbert, P L; Yadava, O P; Hankey, G J; Stewart-Wynne, E G.

In: Australian and New Zealand Journal of Medicine, Vol. 24, No. 2, 04.1994, p. 154-60.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mechanism of stroke complicating cardiopulmonary bypass surgery

AU - Rankin, J M

AU - Silbert, P L

AU - Yadava, O P

AU - Hankey, G J

AU - Stewart-Wynne, E G

PY - 1994/4

Y1 - 1994/4

N2 - BACKGROUND: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.AIMS: To determine the incidence, pathology and aetiology of stroke complicating CPB.METHODS: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.RESULTS: Twenty-one (1.6%, 95% CI 0.9-2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36-78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22-64%) due to hypoperfusion in a borderzone.CONCLUSIONS: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.

AB - BACKGROUND: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.AIMS: To determine the incidence, pathology and aetiology of stroke complicating CPB.METHODS: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.RESULTS: Twenty-one (1.6%, 95% CI 0.9-2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36-78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22-64%) due to hypoperfusion in a borderzone.CONCLUSIONS: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Australia/epidemiology

KW - Cardiopulmonary Bypass/adverse effects

KW - Cerebral Infarction

KW - Cerebrovascular Disorders/classification

KW - Female

KW - Humans

KW - Incidence

KW - Intracranial Embolism and Thrombosis

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Tomography, X-Ray Computed

M3 - Article

VL - 24

SP - 154

EP - 160

JO - Australian & New Zealand Journal of Medicine

JF - Australian & New Zealand Journal of Medicine

SN - 0004-8291

IS - 2

ER -