Pattern and significance of cerebral microemboli during coronary artery bypass grafting.
BACKGROUND
Strokes that occur during coronary artery bypass grafting are often caused by embolism. Intraoperative transcranial Doppler monitoring can detect cerebral microemboli. The aims of this study were to identify the pattern of microembolic phenomena during various stages of coronary artery bypass grafting, to verify whether numbers of high-intensity transient signals correlated with early neuropsychologic deficits, and to identify, using magnetic resonance imaging scans, whether radiologic evidence of cerebral infarction correlated with microembolic numbers during the bypass period.


METHODS
Forty-one consecutive patients undergoing coronary bypass grafting with transcranial Doppler monitoring were enrolled in this study. All had preoperative and postoperative magnetic resonance imaging brain scans. A subgroup of 32 patients were studied by comparing microembolic load and early neuropsychological outcomes.


RESULTS
Transcranial Doppler monitoring confirmed that most microemboli occurred during cardiopulmonary bypass. A significant early neuropsychological deficit after coronary artery bypass grafting did correspond to the total microembolic load during bypass (p = 0.008). However, patients with cerebral infarction on magnetic resonance imaging had significantly more microembolic signal during the preincision phases and not during the bypass period.


CONCLUSIONS
Microembolic load during bypass is associated with early neuropsychologic deficits. In contrast, patients who show evidence of strokes during coronary artery bypass grafting have a higher microembolic load during the preincision phase than those without cerebral infarction. Differing mechanisms may be responsible for these different outcomes.
Sylivris
S
S
Department of Cardiology, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Levi
C
C
Matalanis
G
G
Rosalion
A
A
Buxton
B F
BF
Mitchell
A
A
Fitt
G
G
Harberts
D B
DB
Saling
M M
MM
Tonkin
A M
AM
D000368:Aged; D002315:Cardiopulmonary Bypass; D002544:Cerebral Infarction / Q000175:diagnosis; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis* / Q000503:physiopathology*; D007431:Intraoperative Complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008991:Monitoring, Physiologic; D009483:Neuropsychological Tests