Author Affiliations: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio (firstname.lastname@example.org).
In Reply: As Dr Fan and colleagues discuss, and we stated as a limitation of our study, we did not report whether the perioperative strokes were due to embolism, thrombosis, hemorrhage, or hypoperfusion. These data are not routinely captured in our prospective database and therefore would require considerable work to obtain. However, from what is known about stroke and coronary surgery, the majority are due to embolism, most likely from manipulation of an atherosclerotic ascending aorta.1 Our findings support this in that stroke increased directly with the number of atherosclerotic risk factors and was lowest for patients with minimal manipulation of the aorta.
Sabik JF, Blackstone EH. Stroke After Coronary Artery Bypass Graft Surgery—Reply. JAMA. 2011;305(21):2171-2172. doi:10.1001/jama.2011.708