Department of Cardiovascular Surgery, Koto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan.
Eur J Cardiothorac Surg. 2010 Nov;38(5):568-72. doi: 10.1016/j.ejcts.2010.03.021.
Cerebrovascular atherosclerotic disease is a widely known risk factor for stroke after conventional coronary artery bypass grafting (CABG). The aim of this study is to evaluate the incidence of stroke in patients with significant cerebrovascular disease after off-pump CABG.
In this retrospective study, 611 patients, who underwent off-pump CABG, were divided into high-risk (n=196) and low-risk groups (n=415) for perioperative stroke using preoperative brain magnetic resonance angiography/imaging and cervical Doppler sonography, and the incidence of stroke in the two groups was compared.
No 'intra-operative' stroke was observed. However, seven patients (3.6%) in the high-risk group and one patient (0.2%) in the low-risk group developed 'delayed stroke' between the day of surgery and postoperative day 18 (mean postoperative day 8.8). The predominant aetiology of delayed stroke was thrombo-embolism. Assignment to the high-risk group had a significant association with the occurrence of delayed stroke (p=0.011). The person-time incidence rate of stroke in the high-risk group was much higher within 1 month (3.57) after CABG than beyond 1 month (0.14).
Patients with significant cerebrovascular disease did not develop intra-operative stroke after off-pump CABG. However, these patients were likely to suffer from delayed stroke within 30 days of surgery.
脑血管粥样硬化性疾病是传统冠状动脉旁路移植术（CABG）后中风的一个众所周知的危险因素。本研究旨在评估有明显脑血管疾病的患者在非体外循环 CABG 后的中风发生率。
在这项回顾性研究中，611 例接受非体外循环 CABG 的患者根据术前脑磁共振血管造影/成像和颈多普勒超声检查分为高危（n=196）和低危组（n=415），比较两组患者的中风发生率。
未观察到“术中”中风。然而，高危组的 7 名患者（3.6%）和低危组的 1 名患者（0.2%）在手术日和术后第 18 天（平均术后第 8.8 天）发生“迟发性中风”。迟发性中风的主要病因是血栓栓塞。高危组的分配与迟发性中风的发生显著相关（p=0.011）。高危组在 CABG 后 1 个月内（3.57）的中风发生率明显高于 1 个月后（0.14）。
有明显脑血管疾病的患者在非体外循环 CABG 后未发生术中中风。然而，这些患者在手术后 30 天内可能会发生迟发性中风。
