Risk factors and predictive markers of postoperative stroke following coronary artery bypass surgery

Аннотация

Postoperative stroke remains one of the most serious complications following coronary artery bypass COPYRIGHT grafting (CABG), contributing significantly to increased © 2025 Original content from this work may be used under the terms mortality, prolonged hospitalization, and long-term of the creative commons attributes 4.0 License. disability. Despite improvements in surgical techniques and perioperative care, identifying patients at risk of postoperative stroke remains a clinical challenge. This study aims to evaluate the key clinical and surgical predictors associated with the development of ischemic stroke in patients undergoing CABG, with a focus on identifying modifiable risk factors and predictive markers. A retrospective analysis was conducted on patients who underwent CABG over a two-year period. Variables assessed included age, comorbid conditions (hypertension, diabetes mellitus, atrial fibrillation), carotid artery disease, duration of cardiopulmonary bypass (CPB), intraoperative hemodynamic instability, and cerebral perfusion strategies. Statistical methods were employed to determine the significance of associations between these factors and stroke occurrence. Advanced age over 70 years, pre-existing cerebrovascular disease, prolonged CPB time over 120 minutes, poorly controlled diabetes, and intraoperative hypotension were identified as independent predictors of postoperative stroke. Carotid artery stenosis and atrial fibrillation also significantly increased stroke risk. A high comorbidity index and prolonged aortic cross- clamping were associated with worse neurological The American Journal of Medical Sciences and Pharmaceutical Research 90 https://www.theamericanjournals.com/index.php/tajmspr The American Journal of Medical Sciences and Pharmaceutical Research outcomes. Early identification of high-risk patients was neuroprotective benefits by reducing cerebral found to improve decision-making in terms of surgical metabolic demands. However, rewarming must be planning and perioperative management. carefully controlled as rapid or excessive rewarming can cause cerebral hyperthermia and edema, potentially Postoperative stroke after CABG is influenced by a worsening neurologic outcomes (Johnson et al., 2020; combination of patient-related, surgical, and Mohr et al., 2013) [6, 7]. hemodynamic factors. A comprehensive risk assessment protocol incorporating both clinical and Pharmacologic management also plays a critical role. procedural markers is essential for prevention. Beta-blockers reduce sympathetic tone and the risk of Tailoring surgical and anesthetic strategies based on arrhythmia but have been associated in some studies individual risk profiles may reduce the incidence and with a paradoxical increase in stroke risk when not severity of neurologic complications. properly titrated (Lamy et al., 2016) [8]. Anticoagulants such as heparin, although essential during CPB, may pose a risk for hemorrhagic transformation, particularly Keywords: Coronary artery bypass grafting, in elderly or high-risk patients (Lee & Kim, 2019) [9]. postoperative stroke, risk factors, ischemic stroke, Insulin therapy in diabetic and non-diabetic patients has predictive markers, cardiopulmonary bypass, aortic shown benefits in reducing deep sternal infections and cross-clamping, cerebrovascular disease, postoperative ischemia, but tight glucose control is comorbidities, intraoperative management. essential to avoid hypoglycemic episodes that may also impact neurologic function. Introduction: Postoperative stroke is one of the most Early identification of at-risk individuals using risk severe complications associated with coronary artery stratification tools and targeted imaging, such as carotid bypass grafting (CABG). It is linked with increased Doppler ultrasonography and preoperative brain hospital stays, long-term disability, and elevated imaging, has been shown to improve clinical outcomes. mortality rates. Despite significant advances in cardiac Tailoring the surgical strategy and optimizing surgical techniques and perioperative monitoring, the perioperative monitoring, including cerebral oximetry, risk of ischemic events remains a prominent concern. can reduce the incidence and severity of neurologic Studies report stroke incidence in CABG patients complications. ranging from 1.5% to 5% depending on age,