Impact of Perioperative Management for Intracranial Arterial Stenosis on Postoperative Stroke Incidence in Coronary Artery Bypass Surgery: A Propensity Matching and Multivariate Analyses

Abstract

Background: Intracranial arterial steno-occlusive lesion (IAS) is the most common cause of stroke. We hypothesized that adequate perioperative management for IAS is useful to prevent stroke in coronary artery bypass grafting (CABG). Methods: IAS was evaluated using magnetic resonance imaging/angiography (MRI/A, n = 216) in patients without a history of stroke or carotid stenosis (≥50%) in CABG between May 2005 and June 2018 (n = 424). Off-pump CABG was performed in most patients. Different perioperative managements of systolic arterial pressure (SAP) were applied for patients with and without MRI/A. SAP was strictly maintained at ≥80 mmHg in patients with significant IAS (≥50%, n = 28) and ≥90 mmHg for severe IAS (≥70%, n = 44) while SAP less than 80 mmHg (usually ≥70 mmHg) was allowed for patients without MRI/A. Intra-aortic balloon pumping was used for patients with multiple severe IAS and/or occlusion. Clinical outcomes were compared between patients with and without MRI/A. Propensity matching was performed (n = 181 each). Results: Complete revascularization was achieved in all patients. Nine patients (2.12%) had postoperative strokes; the incidence of stroke was signifi-cantly less in patients with preoperative MRI/A (n = 1, p = 0.016). There was no significant difference in the incidence of in-hospital mortality between patients with and without preoperative MRI/A (0.5% and 1.0%, respectively; p = 0.529). Multivariate analysis revealed that no preoperative MRI/A was the only significant predictors of postoperative stroke ( p = 0.045). The incidence of stroke was not higher in patients with IAS who underwent MRI/A ( p = 0.332). Conclusions: Preoperative evaluation of IAS using MRI/A and following our perioperative management significantly reduced perioperative stroke in patients undergoing CABG.