Coronary artery bypass grafting (CABG) has evolved to become an incredibly safe and effective therapy for ischaemic heart disease. Despite advances in revascularization both with and without cardiopulmonary bypass, cerebrovascular events continue to occur following CABG. Many of these events have been directly related to aortic manipulation (cannulation, aortic clamping, proximal anastomotic devices), and this fact has led a number of surgeons to consider and implement a surgical revascularization strategy whereby the aorta is not manipulated at all. This ‘no-touch’ technique utilizes a number of conduits and orientations in order to achieve complete myocardial revascularization while eliminating aortic manipulation and significantly decreasing the risk of perioperative stroke. Outcomes of patients who suffer a permanent stroke after CABG are dismal. In-hospital mortality rates for patients suffering a permanent stroke after CABG have been reported to be as high as 13.5%. Following discharge from the hospital, patients who suffered a perioperative stroke have a significantly higher risk of mortality within the first year following surgery.
