Abstract
Objectives: To investigate the lesion patterns and predictors of silent brain infarction after coronary artery bypass graft (CABG) surgery and propose a mechanism. Background: New brain infarcts after CABG are markedly more frequent than clinically evident stroke and are thought to be associated with postoperative cognitive decline. Thus, identification of the mechanism and risk factors of postoperative silent brain infarction may be clinically relevant. Methods: This was a prospective pre- and postoperative brain MRI study in consecutive patients who underwent isolated CABG. Preoperative MRI included diffusion-weighted imaging (DWI) and magnetic resonance angiography. DWI was repeated on postoperative day 3. Clinical variables, intraoperative findings, and laboratory findings were compared between patients with and without new brain infarcts on DWI. Results: Of a total of 127 included patients, 35 (27.6%) showed new brain infarcts on DWI. Most lesions were clinically silent, were located in the cortical territory (80%), were small (<1.5 cm) in diameter (89%), and were not related to the underlying cerebral arterial abnormality (80%) (Figure). Old age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.15), use of cardiopulmonary bypass (OR, 3.12; 95% CI, 1.13-8.57), a moderate to severe aortic plaque (OR, 21.17; 95% CI, 2.01-222.58), and high levels of high-sensitivity C-reactive protein (OR, 1.35; 95% CI, 1.08-1.70) were independent predictors of new brain infarction. Conclusions: New brain infarcts on DWI after CABG are frequent and mostly silent. Aortogenic embolisms and a systemic inflammatory response may contribute to the pathogenesis of new brain infarcts.
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