title: Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis.
abstract: OBJECTIVE
  We aimed to define the relationship between cerebral atherosclerosis and stroke after coronary artery bypass grafting (CABG).
  
  
  BACKGROUND
  Although cerebral atherosclerosis may play a crucial role in the advent of post-CABG stroke, only extracranial carotid artery disease has been extensively studied, and the effects of atherosclerosis on the mechanisms underlying post-CABG stroke remain unclear.
  
  
  METHODS
  Pre-operative magnetic resonance angiography was performed on 1,367 consecutive CABG patients to assess intracranial and extracranial cerebral atherosclerosis. Disease severity was evaluated by atherosclerosis score, as determined by the number of steno-occlusions of cerebral arteries and the degree thereof. Post-CABG strokes (within 14 days) were classified as atherosclerotic (strokes attributable to pre-defined atherosclerosis) or other (strokes caused by other mechanisms). Associations between post-CABG stroke and each type of atherosclerotic disease (extracranial carotid artery disease, intracranial, extracranial, or extracranial and/or intracranial cerebral atherosclerosis), differentiated according to the involved arteries, were analyzed.
  
  
  RESULTS
  Stroke occurred in 33 patients, and the atherosclerosis score was independently associated with stroke development (odds ratio: 1.35; 95% confidence interval: 1.16 to 1.56). Atherosclerotic stroke was defined in 15 (45%), and constituted >40% of both immediate (within 24 h) and delayed strokes. Intracranial, extracranial, and extracranial and/or intracranial cerebral atherosclerosis were significantly associated with stroke.
  
  
  CONCLUSIONS
  Cerebral atherosclerosis was closely related to the occurrence of post-CABG stroke, being both an independent risk factor for and the cause of a significant proportion of strokes. Pre-operative evaluation of intracranial and extracranial cerebral arteries, apart from the extracranial carotid artery, may be useful to predict the likelihood of post-CABG stroke.
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Eun-Jae
authors.initials: EJ
authors.lastname: Lee
authors.forename: Kyoung-Hyo
authors.initials: KH
authors.lastname: Choi
authors.forename: Ju-Seok
authors.initials: JS
authors.lastname: Ryu
authors.forename: Sang-Beom
authors.initials: SB
authors.lastname: Jeon
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Suk-Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol-Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000473:pathology*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012042:Registries; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*