Hemispheric stroke following cardiac surgery: a case-control estimate of the risk resulting from ipsilateral asymptomatic carotid artery stenosis

[Interdisciplinary questions of stroke therapy]

Numerous multicenter, randomized, preventive and therapeutic stroke trials have been initiated or already finished in the last years. Due to some positive results the stroke societies have elaborated the new guidelines for stroke prevention and therapy, based on the results of evidence based medicine. Unfortunately, in daily practice, the neurologist, vascular and cardiac surgeon, cardiologist or internist have to answer many interdisciplinary questions of stroke prevention or therapy. Because of the lack of large, international trials, the author summarizes the most important publications and his personal experience regarding the interdisciplinary questions (stroke in hospital, endarterectomy and CABG, stent or endarterectomy, complications after CEA) of stroke care.

Is there any impact of the shape of aortic end-hole cannula on stroke occurrence? clinical evaluation of straight and bent-tip aortic cannulae

OBJECTIVE

To compare the impact of straight and bent-tip aortic cannulae on stroke occurrence, location, and severity.

METHODS

Prospective data were collected on 8,129 patients (coronary artery bypass grafting (CABG) and/or valvular surgery). 'Bent-tip' aortic cannulae were used in 15.6% of cases and 'straight' end-hole cannulae in 84.4% of cases.

RESULTS

There were a total of 137 strokes: right anterior 52, left anterior 39, bilateral 23, posterior 18, and location not established 5. With the use of bent-tip cannulae, the incidence of strokes was 0.9% versus 1.8% with straight cannulae (chi2, p = 0.026). Bilateral and posterior strokes occurred more often with the use of straight cannulae (chi2, p = 0.015). Straight cannulae also related to the severity of strokes (chi2, p = 0.003).

CONCLUSIONS

There is an influence of the type of cannula on the occurrence, location, and severity of strokes. Straight cannulae cause significantly more often and more severe bilateral and posterior strokes than bent-tip cannulae.