Postoperative stroke and encephalopathy are potentially serious complications associated with coronary artery bypass grafting. In this case report a 78-year-old male patient receiving routine elective cardiac surgery presented with microaggregations in the sublingual microcirculation while on cardiopulmonary bypass that was undetected by routine intraoperative anticoagulation assessment. Microaggregates identified using video microscopy on his sublingual microcirculation during the procedure preceded a stroke postoperatively. Postoperative cerebral and carotid artery examination with computed tomography scanning revealed a left watershed cerebral infarct with carotid stenosis. This report presents intraoperative microcirculation-based evidence suggesting that observations of microaggregations, otherwise undetected by conventional anticoagulation assessment techniques, could serve as an early warning in elderly patients at high risk for postoperative cerebrovascular events.
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Oi K, Arai H (2015) Stroke associated with coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 63:487–495
Tarakji KG, Sabik JF, Bhudia SK, Batizy LH, Blackstone EH (2011) Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA 305:381–390
Masabni K, Raza S, Blackstone EH, Gornik HL, Sabik JF (2015) Does preoperative carotid stenosis screening reduce perioperative stroke in patients undergoing coronary artery bypass grafting? J Thorac Cardiovasc Surg 149:1253–1260
Mickleborough LL, Walker PM, Takagi Y, Ohashi M, Ivanov J, Tamariz M (1996) Risk factors for stroke in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 112:1250–1258
John R, Choudhri AF, Weinberg AD, Ting W, Rose EA, Smith CR, Oz MC (2000) Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg 69:30–35
Lynn GM, Stefanko K, Reed JF, Gee W, Nicholas G (1992) Risk factors for stroke after coronary artery bypass. J Thorac Cardiovasc Surg 104:1518–1523
Yuruk K, Bezemer R, Euser M, Milstein DM, de Geus HH, Scholten EW, de Mol BA, Ince C (2012) The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg 15:364–370
Kara A, Akin S, Ince C (2016) The response of the microcirculation to cardiac surgery. Curr Opin Anaesthesiol 29:85–93
Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C (2007) Sidestream dark field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express 15:15101–15114
Milstein DM, Bezemer R, Ince C (2012) Sidestream dark-field (SDF) video microscopy for clinical imaging of the microcirculation. In: Leahy MJ (ed) Microcirculation imaging, Wiley, Weinheim, pp 37–52
Dobbe JG, Streekstra GJ, Atasever B, van Zijderveld R, Ince C (2008) Measurement of functional microcirculatory geometry and velocity distributions using automated image analysis. Med Biol Eng Comput 46:659–670
Atasever B, Boer C, Goedhart P, Biervliet J, Seyffert J, Speekenbrink R, Schwarte L, de Mol B, Ince C (2011) Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 25:784–790
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Uz, Z., Milstein, D.M.J., Ince, C. et al. Circulating microaggregates during cardiac surgery precedes postoperative stroke. J Thromb Thrombolysis 44, 14–18 (2017). https://doi.org/10.1007/s11239-017-1509-x
- Cardiac surgery
- Cardiopulmonary bypass