Umeå University Medical Dissertations

................................................................................................................................................. 5 POPULÄRVETENSKAPLIG SAMMANFATTNING PÅ SVENSKA ....................................................................... 6 ORIGINAL PAPERS ...................................................................................................................................... 7 ABBREVIATIONS ......................................................................................................................................... 8 TABLE OF CONTENTS .................................................................................................................................. 9 INTRODUCTION ........................................................................................................................................ 11 STROKE DEFINITIONS ........................................................................................................................................ 11 STROKE IN THE GENERAL POPULATION .................................................................................................................. 11 STROKE IN CONJUNCTION WITH OTHER PROCEDURES THAN CARDIAC SURGERY.............................................................. 11 STROKE AND OTHER NEUROLOGICAL COMPLICATIONS IN CARDIAC SURGERY ................................................................. 11 RISK FACTORS FOR STROKE IN CARDIAC SURGERY .................................................................................................... 11 STROKE MECHANISMS IN CARDIAC SURGERY .......................................................................................................... 12 HEMISPHERIC DISTRIBUTION OF STROKE ............................................................................................................... 12 SURVIVAL AFTER STROKE ................................................................................................................................... 12 SURGICAL STRATEGIES TO AVOID CEREBRAL EMBOLIZATION ...................................................................................... 12 AIMS ........................................................................................................................................................ 13 MATERIAL AND METHODS ....................................................................................................................... 15 STUDY I-III ..................................................................................................................................................... 15 STUDY IV ....................................................................................................................................................... 17 STUDY V ........................................................................................................................................................ 18 STATISTICS ...................................................................................................................................................... 19 ETHICS ........................................................................................................................................................... 20 RESULTS ................................................................................................................................................... 21 STROKE RATE .................................................................................................................................................. 21 RISK FACTORS.................................................................................................................................................. 21 SYMPTOMS AND CT-FINDINGS ........................................................................................................................... 22 VASCULAR DISTRIBUTION OF STROKE .................................................................................................................... 22 FACTORS ASSOCIATED WITH HEMISPHERIC DIFFERENCES ........................................................................................... 23 SURVIVAL ....................................................................................................................................................... 24 PARTICLES GENERATED AT AORTIC CROSS-CLAMPING ............................................................................................... 25 PARTICLES GENERATED AT AORTIC CANNULATION ................................................................................................... 26 GENERAL DISCUSSION .............................................................................................................................. 27 RISK FACTORS FOR STROKE ................................................................................................................................. 27 SURVIVAL AFTER STROKE ................................................................................................................................... 27 HEMISPHERIC DISTRIBUTION OF STROKE ............................................................................................................... 28 PARTICLES GENERATED BY AORTIC MANIPULATION .................................................................................................. 29 LIMITATIONS ................................................................................................................................................... 30 CLINICAL IMPLICATIONS ..................................................................................................................................... 30 CONCLUSIONS .......................................................................................................................................... 33 ACKNOWLEDGEMENTS ............................................................................................................................ 35 REFERENCES ............................................................................................................................................. 37 STUDY I .................................................................................................................................................... 41 STUDY II ................................................................................................................................................... 51 STUDY III .................................................................................................................................................. 63 STUDY IV .................................................................................................................................................. 73 STUDY V ................................................................................................................................................... 81 Stroke during cardiac surgery; risk factors, mechanisms and survival effects