Intracranial cerebral artery disease as at risk factor for central nervoussystem complications of coronary artery bypass graft surgery

Background and Purpose-Although extracranial carotid artery disease (ECAD) is accepted as a risk factor for central nervous system (CNS) complications after coronary artery bypass graft (CABG) surgery, it remains to be clarif ied whether intracranial cerebral artery disease (ICAD) may also increase t he risk. We conducted a prospective study to elucidate the relation between ICAD and CNS complications after CABG surgery. Methods-We prospectively studied 201 patients undergoing nonemergency isola ted CABG surgery during a 39-month period (from March 1995 to June 1998). E ach patient was evaluated before surgery with neurological examination, tra nscranial Doppler, and carotid duplex ultrasonography. Magnetic resonance a ngiography was used to determine the presence and severity of ECAD and ICAD in patients with abnormal findings on clinical examination, carotid duplex ultrasonography, or transcranial Doppler. Patients were followed after sur gery and evaluated for the development of CNS complications. Association be tween CNS complications and their potential predictors was analyzed. Results-One hundred nine patients (54.2%) were found to have ECAD and/or IC AD. ECAD alone was found in 48 patients (23.9%), ICAD alone in 33 (16.4%), and both ECAD and ICAD in 28 (13.9%). Fifty-one patients (25.4%) had single or multiple CNS complications: 23 (11.4%) had delirium; 18 (9.0%) had hypo xic-metabolic encephalopathy; 7 (3.5%) had stroke; and 7 (3.5%) had seizure . In multivariate analysis, ICAD was found to have an independent associati on with the development of CNS complications (prevalence OR, 2.28; 95% CI, 1.04 to 5.01) after controlling for covariates including age, occurrence of intraoperative events, and reoperation. The joint effect of ECAD and ICAD was also statistically significant and stronger than ICAD alone (prevalence OR, 3.87; 95% CI, 1.80 to 6.52). Conclusions-Our results suggest that ICAD may be an independent risk factor for CNS complications after CABG surgery. These results support pre-CABG e valuation of the intracranial arteries for the risk assessment of CABG surg ery, at least in black and Asian patients, in whom there may be a higher pr evalence of intracranial arterial stenosis.