Craniocervical and aortic atherosclerosis as neurologic risk factors in coronary surgery

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.