Chulalongkorn Medical Journal


Background: Few cases of patients of previous studies have provided information on imaging patterns of stroke after cardiac surgery. Objective: The purpose of this study was to determine the incidence and imaging pattern of stroke after cardiac surgery according to type of cardiac surgery. Methods: A retrospective observational study was conducted on 3,645 adult patients who underwent cardiac surgery in cardiovascular thoracic unit at our institute from January 1, 2010 – September 30, 2019. Cases of patients who were suspected of having post-operative stroke and on whom brain imaging had been performed were reviewed. The ischemic stroke was categorized into four subtypes including large territorial infarction, multiple scattered infarctions, small infarction, and watershed infarction. Results: Stroke after cardiac surgery was suspected in 90 patients. Sixty-seven patients (1.8%) had a diagnosis of ischemic stroke confirmed by imaging. The incidence of stroke in combined cardiac procedure with carotid bypass surgery was significantly high, especially in thoracic endovascular aortic repair (TEVAR) with carotid bypass surgery (P < 0.001). Multiple scattered infarctions (61.2%) was the most common pattern which was predominant in both anterior and posterior circulation. It was found to have no significant association between type of surgery and pattern of stroke (P = 0.70). Overall, stroke related death within 30 days post cardiac surgery was 0.2% (7/3645). Conclusions: Procedures that included carotid bypass surgery increased the incidence of stroke after cardiac surgery significantly, especially TEVAR with carotid bypass surgery. The most common pattern of stroke after cardiac surgery was the multiple scattered pattern.


Faculty of Medicine, Chulalongkorn University



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