Recurrence of Stroke After Cardiac Surgery: Insight Into Pathogenesis via Diffusion-Weighted and Continuous Arterial Spin Labeling Perfusion Magnetic Resonance Imaging

Abstract

STROKE AFTER CARDIAC surgery occurs with a higher incidence in patients with a history of prior stroke 1 Redmond J.M. Greene P.S. Goldsborough M.A. et al. Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996; 61: 42-47 Abstract Full Text PDF PubMed Scopus (88) Google Scholar , 2 Hogue Jr, C.W. De Wet C.J. Schechtman K.B. et al. The importance of prior stroke for the adjusted risk of neurologic injury after cardiac surgery for women and men. Anesthesiology. 2003; 98: 823-829 Crossref PubMed Scopus (30) Google Scholar and is often delayed. 3 Peel G.K. Stamou S.C. Dullum M.K. et al. Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass. J Am Coll Cardiol. 2004; 43: 752-756 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 4 Hogue Jr, C.W. Murphy S.F. Schechtman K.B. et al. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999; 100: 642-647 Crossref PubMed Scopus (437) Google Scholar Recurrence of stroke after cardiac surgery, thought to be primarily embolic in nature, 5 Libman R.B. Wirkowski E. Neystat M. et al. Stroke associated with cardiac surgery Determinants, timing, and stroke subtypes. Arch Neurol. 1997; 54: 83-87 Crossref PubMed Scopus (99) Google Scholar , 6 Borger M.A. Ivanov J. Weisel R.D. et al. Stroke during coronary bypass surgery: Principal role of cerebral macroemboli. Eur J Cardiothorac Surg. 2001; 19: 627-632 Crossref PubMed Scopus (94) Google Scholar , 7 Likosky D.S. Marrin C.A. Caplan L.R. et al. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke. 2003; 34: 2830-2834 Crossref PubMed Scopus (237) Google Scholar has been noted to frequently follow the anatomic and vascular distribution of the previous stroke. 1 Redmond J.M. Greene P.S. Goldsborough M.A. et al. Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996; 61: 42-47 Abstract Full Text PDF PubMed Scopus (88) Google Scholar Stroke is more frequent after aortic valve replacement for aortic stenosis than after coronary artery bypass grafting 8 Wolman R.L. Nussmeier N.A. Aggarwal A. et al. Multicenter Study of Perioperative Ischemia Research Group (McSPI) and the Ischemia Research Education Foundation (IREF) InvestigatorsCerebral injury after cardiac surgery: Identification of a group at extraordinary risk. Stroke. 1999; 30: 514-522 Crossref PubMed Scopus (254) Google Scholar , 9 Stolz E. Gerriets T. Kluge A. et al. Diffusion-weighted magnetic resonance imaging and neurobiochemical markers after aortic valve replacement: Implications for future neuroprotective trials?. Stroke. 2004; 35: 888-892 Crossref PubMed Scopus (91) Google Scholar but may be, in both types of surgery, related to the extent of calcification in the ascending aorta 10 Barbut D. Gold J.P. Aortic atheromatosis and risks of cerebral embolization. J Cardiothorac Vasc Anesth. 1996; 10: 24-30 Abstract Full Text PDF PubMed Scopus (47) Google Scholar , 11 van der Linden J. Hadjinikolaou L. Bergman P. et al. Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta. J Am Coll Cardiol. 2001; 38: 131-135 Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar , 12 Djaiani G. Fedorko L. Borger M. et al. Mild-to-moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. Stroke. 2004; 35: e356-e358 Crossref PubMed Google Scholar or within the valve itself.