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Stroke after cardiac surgery - hemispheric distribution and survival
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2013 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 47, no 3, 136-144 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. Stroke following cardiac surgery may occur either in association with surgery (early) or occur postoperatively (delayed). The hemispheric distribution of lesions may provide information about embolic routes, which was analyzed here. Design. In 10,809 patients undergoing cardiac surgery, early (n = 223) and delayed stroke (n = 116) were explored. Symptoms and computed tomography findings were evaluated to categorize hemispheric distributions. This was compared with pre- and intra-operative characteristics and survival, using logistic regression and Kaplan-Meier statistics. Results. Early stroke had preponderance for the right rather than the left hemisphere (P = 0.009), whereas delayed stroke had a uniform distribution. Several intraoperative variables predicted the development of bilateral stroke compared with its unilateral counterpart. At multivariable analysis, the use of tranexamic acid was associated with bilateral stroke (P = 0.017), but was also associated with right rather than left-hemispheric stroke (P = 0.001). Bilateral lesions dramatically impaired survival versus those with unilateral lesions (P < 0.001). There was no survival difference between left and right-hemispheric stroke. Conclusions. When stroke, after cardiac surgery, is subdivided into early and delayed forms, it becomes evident that early, but not delayed stroke, demonstrates a hemispheric side difference. The preponderance for right-hemispheric lesions may indicate embolic mechanisms routed via the brachiocephalic trunk.

Place, publisher, year, edition, pages
2013. Vol. 47, no 3, 136-144 p.
Keyword [en]
cardiac surgery, delayed, early, hemispheric, stroke survival
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:umu:diva-76806DOI: 10.3109/14017431.2012.737016ISI: 000320351700003OAI: diva2:637141
Available from: 2013-07-16 Created: 2013-07-15 Last updated: 2014-02-14Bibliographically approved

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Hedberg, MagnusEngström, Karl Gunnar
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