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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stroke is a significant cause of morbidity and mortality following coronary artery bypass grafting (CABG). Over a 30-month period, 245 consecutive patients undergoing elective CABG were prospectively examined to determine which risk factors might predispose to stroke following surgery. The risk factors evaluated included hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, smoking, atrial fibrillation, a history of cerebrovascular accident or transient ischemic attack, carotid artery stenosis > 60% documented by duplex scanning, severe atherosclerosis of the ascending aorta, and the presence of ventricular thrombus. Postoperative stroke occurred in five of the 245 patients (2%), four evident immediately on awakening and one on day 7 after surgery. The probable causes of the immediate strokes were atheroembolism in three patients and severe ipsilateral carotid stenosis in one. Hypertensive hemorrhage was responsible for the one case of delayed stroke. In this study, carotid artery stenosis did not presage stroke following CABG, but ventricular thrombus was highly predictive of stroke after surgery.
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PMID:Risk factors for stroke in patients undergoing coronary artery bypass grafting. 807 23

Stroke is an important cause of morbidity and mortality after cardiovascular surgery and its incidence has been reported as 1.5 to 8.7%. Preexisting cerebrovasuclar disease, stenotic lesions of the carotid artery and atherosclerosis of the ascending aorta are known to be significant anatomic risk factors. To prevent perioperative stroke, it is important to discuss the onset mechanisms. Intraoperative stroke is mainly caused by the embolization of scattered atheroscrelotic plaque. Carotid duplex scanning and magnetic resonance imaging (MRI) are useful methods for the preoperative screening of cerebrovascular stenosis and plaque. Enhanced computed tomography (CT) is a powerful tool to estimate the presence of severe atheroscrelotic plaque in the aorta. When severe plaque is present, the manipulation, cannulation or clamping of the diseased aortic segment should be prevented. Insufficient oxygenated brain blood flow is thought to be another mechanism of intraoperative stroke. Impaired cerebral autoregulation during caridopulmonary bypass has been reported. Thus, it is recommended to maintain a high mean arterial pressure during cardiopulmonary bypass, especially in patients with cerebrovasuclar occlusive diseases. Postoperative stroke is mainly caused by embolization of the thrombus. To prevent this, excessive hypovolemia and atrial fibrillation should be avoided. Preemptive usage of beta blockers is one option for preventing postoperative atrial fibrillation.
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PMID:[The Perioperative Management and Operative Strategy for Prevention of Stroke in Cardiovascular Surgery]. 3313 Jul 56