Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting

Background. This study was designed to evaluate the efficacy of a protocol of systematic screening of the ascending aorta and internal carotid arterie s and individualization of the surgical strategy to the ascending aorta and internal carotid arteries status in reducing the stroke incidence among pa tients undergoing coronary artery bypass grafting. Methods. On the basis of a pre- and intraoperative screening of the ascendi ng aorta and internal carotid arteries, 2,326 consecutive patients undergoi ng coronary artery bypass grafting were divided in low, moderate, and high neurologic risk groups. In the high-risk group dedicated surgical technique s were always adopted and the reduction of the neurologic risk tvas conside red more important than the achievement of total revascularization. Results. The incidence of perioperative stroke in the high-risk group was s imilar to those of the other two groups (1.1 versus 1.3 and 1.1%, respectiv ely; p = not significant); however, angina recurrence was significantly mor e frequent in the high-risk group. Conclusions. The described strategy allows a low rate of perioperative stro ke in high-risk patients undergoing coronary artery bypass grafting. Whethe r the reduction of the neurologic risk outweighs the benefits of complete r evascularization remains to be determined. (Ann Thorac Surg 1999;67:1246-53 ) (C) 1999 by The Society of Thoracic Surgeons.