Background. Advanced age is associated with increased systemic atherosclero
sis and is a consistent neurologic risk factor after coronary artery bypass
grafting (CABG).
Methods. We studied prospectively whether varying degrees of a total athero
sclerotic score derived from the brain, carotid arteries, and ascending aor
ta predicted postoperative neuropsychologic (NP) dysfunction and stroke in
177 elderly patients (greater than or equal to 60 years) undergoing CABG.
Results. Group L Claw total atherosclerotic score) had rates of NP dysfunct
ion of 25% and 4%, group I (intermediate) had rates of 33% and 22%, and gro
up H (high) had rates of 79% and 43% on postoperative days 1 and 7, respect
ively (p < 0.001). The incidence of stroke was higher in group H (14.3%) th
an in groups I and L (7.8% and 0.9%; p = 0.013). stepwise logistic regressi
on analysis demonstrated the significant predictors of NP dysfunction on po
stoperative day 7 to be total atherosclerotic scare, peripheral vascular di
sease, and diabetes mellitus, and those of stroke to be total atherosclerot
ic score, peripheral vascular disease, and hyperlipidemia.
Conclusions. Perioperative evaluation of craniocervical and aortic atherosc
lerosis is useful to identify a high-risk patient at postoperative NC dysfu
nction and stroke after CABG.