Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting.
BACKGROUND
This study was designed to evaluate the efficacy of a protocol of systematic screening of the ascending aorta and internal carotid arteries and individualization of the surgical strategy to the ascending aorta and internal carotid arteries status in reducing the stroke incidence among patients undergoing coronary artery bypass grafting.


METHODS
On the basis of a pre- and intraoperative screening of the ascending aorta and internal carotid arteries, 2,326 consecutive patients undergoing coronary artery bypass grafting were divided in low, moderate, and high neurologic risk groups. In the high-risk group dedicated surgical techniques were always adopted and the reduction of the neurologic risk was considered more important than the achievement of total revascularization.


RESULTS
The incidence of perioperative stroke in the high-risk group was similar to those of the other two groups (1.1 versus 1.3 and 1.1%, respectively; p = not significant); however, angina recurrence was significantly more frequent in the high-risk group.


CONCLUSIONS
The described strategy allows a low rate of perioperative stroke in high-risk patients undergoing coronary artery bypass grafting. Whether the reduction of the neurologic risk outweighs the benefits of complete revascularization remains to be determined.
Gaudino
M
M
Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@pelagus.it
Glieca
F
F
Alessandrini
F
F
Cellini
C
C
Luciani
N
N
Pragliola
C
C
Schiavello
R
R
Possati
G
G
D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D015150:Echocardiography, Doppler; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk