Barbut D, Grassineau D, Lis E, Heier L, Hartman G S, Isom O W
Department of Neurology, Cornell University Medical College, New York, New York, USA.
Ann Thorac Surg. 1998 Jun;65(6):1656-9. doi: 10.1016/s0003-4975(98)00272-0.
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.
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).
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%).
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.
在相当数量的患者中，中风使心脏外科手术变得复杂。中风的机制主要是栓塞性的，尽管低灌注可能起一定作用。本研究的目的是确定该人群的影像学表现是否与栓塞原因相符。
我们回顾了24例心脏手术后发生中风患者的计算机断层扫描和病历。19例患者（79%）在24小时时出现明显中风。16例患者梗死灶为多发，3例为单发（第1组）。其余5例患者在24小时后发生中风，计算机断层扫描显示为单发梗死灶（第2组）。
在第1组中，15例患者（79%）有双侧小脑梗死，4例（74%）有大脑后动脉梗死，10例（53%）有后分水岭梗死，11例患者（58%）有大脑中动脉分支梗死。累及的血管区域平均数量为5.1个（范围为1至10个）。第1组9例患者中有5例（56%）升主动脉或主动脉弓存在活动动脉粥样硬化斑块。在第2组中，5例患者中有3例（60%）中风与心房颤动或心室颤动密切相关。
在有梗死影像学证据的患者中，心脏手术后围手术期中风通常为多发，且累及脑后部，这与动脉粥样硬化栓塞相符。延迟性中风可能归因于心源性栓塞。
