Intracranial atherosclerosis as a risk factor for ischemic stroke during open heart surgery.
BACKGROUND
Embolic stroke is a feared complication after open heart surgery. Many patients undergo testing of the carotid arteries before surgery, but intracranial atherosclerosis is not commonly assessed as a mechanism.


METHODS
We reviewed a prospectively maintained database of all open heart surgeries at our institution from 2005 to 2007 for patients who developed a periprocedural ischemic stroke. These patients were assessed for the mechanism of stroke through radiographic imaging of the intracranial circulation to determine the frequency of intracranial atherosclerosis as a mechanism for perioperative stroke.


RESULTS
A total of 10,367 patients underwent open heart surgery from 2005 to 2007 and 180 (1.74%) patients were noted to have an ischemic stroke. Of the 180 patients, 98 (55%) underwent intracranial imaging and 29 (30%) were noted to have narrowing of an intracranial vessel. Seventeen (17.4%) patients were found to have infarct ipsilateral to the stenosis, but 8 (8.1%) of these patients were also noted to have infarcts in other vascular territories. Thus, 9 (9.1%) patients were thought to have a stroke solely related to the intracranial stenosis.


CONCLUSIONS
Intracranial atherosclerosis may be an underreported mechanism for perioperative stroke after open heart surgery. Further study is required to better understand the prevalence of the disease in this population and subsequent risk of stroke.
Cheng-Ching
Esteban
E
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Fong
Joanna
J
Ontaneda
Daniel
D
Hussain
Muhammad Shazam
MS
Katzan
Irene
I
Gupta
Rishi
R
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*