Preoperative cerebrovascular screening before cardiovascular surgery in a high risk area of cerebrovascular events in Japan

Background. Cerebrovascular disease and cervical artery diseases are potent ially treatable conditions that are associated with an increased incidence of stroke after cardiac surgery. This prospective study was designed to det ermine the prevalence of cerebrovascular diseases in the high risk populati on of cerebrovascular event including some young patients in Japan and esta blish the strategy for cardiac surgery of patients with cerebrovascular dis ease. Methods, 100 (71 male, 29 female) of 126 consecutive patients undergoing ca rdiac surgery under cardiopulmonary bypass were screened for the presence o f cerebrovascular disease by Intra-arterial angiogram. Results. In seven patients angiographic evaluation disclosed some evidence of cerebrovascular disease for 50% or greater stenosis or cerebral aneurysm . Preoperative Tc-99m-Hexamethyl propylene amino oxime (Tc-99m-HMPAO) singl e emission computed tomography (SPECT) with combination of balloon arterial occlusion test provided detailed Information of cerebral ischemic toleranc e and reliable decision making for surgical repair of cerebrovascular disea se. No deaths were recorded and a small stroke in one patient. Conclusions. We concluded that cerebrovascular screening in patients with c ardiovascular disease may be requested in a high risk population of cerebro vascular events.