Panvascular inflammation and mechanisms of injury in perioperative CNS outcomes.

In this review, the evidence for inflammatory processes as being of fundamental importance in end-organ dysfunction- specifically stroke and neurocognitive impairment in patients undergoing cardiac surgery-will be reviewed. The risk of central nervous system (CNS) impairment following an off-pump cardiac surgery will be contrasted with that of patients undergoing percutaneous coronary intervention (PCI) or medical management, and the role of progression of underlying cerebrovascular disease and, in particular, panvascular inflammation as an accompaniment to unstable angina with attendant risk of stroke will be explored. In addition, the various roles of preoperative comorbidities, aortic atheroma, and the use of selective avoidance of aortic instrumentation as well as carotid endarterectomy as risk modification strategies will be evaluated. Finally, a summary of recommendations for strategies to decrease risk of perioperative CNS impairment will be presented.