Coronary Artery Bypass and Stroke: Incidence, Etiology, Pathogenesis, and Surgical Strategies to Prevent Neurological Complications

Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke. Among the strategies to decrease or eliminate aortic manipulation, there is the use of off-pump coronary artery bypass grafting (CABG) through an aortic “no touch” technique, which reduces significantly the stroke rate. However, this off-pump aortic “no touch” tech-nique is not always applicable, and, when saphenous vein and/or free arterial aortocoronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomosis sewing. We aim to analyze the current incidence, etiology, and physiopathology of the neurological complications after coronary artery bypass surgery. We describe the methods and techniques that provide reduction in the occurrence of neuro-logical complications. CABG with multiple clamp technique failed to find a better outcome in terms of neuropsychological deficit in the OPCABG group. By the way, patients undergoing CABG with single clamping seems to have better outcomes, suggesting that the cross-clamp-ing technique used and minimal aortic manipulation could have had a role in reducing neu-rocognitive impairment. Moreover, surprisingly, CPB seemed to be a neuroprotective factor, and this aspect could be linked to the mild hypothermia used during on-pump surgery.