CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 120 AFRICA (group 2). One patient in each group (1.13% in group 1 and 1.20% in group 2) developed postoperative stroke, indicating no statistically significant difference between the groups (p > 0.005). In addition, one patient in each group died, indicating similar mortality rates between the groups (p > 0.005). Several authors have reported that cerebralmicro-embolisation during CPB mostly occurs during aortic cannulation and insertion and removal of the aortic cross-clamp.23,28,29,34 However, it is difficult to identify the true source of embolism since atherosclerosis of the ascending aorta and carotid and cerebral arteries themselves can result in cerebral embolism.39 In an autopsy study of 1 486 patients, Sternby35 reported that severe atherosclerotic disease was more frequently located in the aortic arch and descending aorta. There were some limitations to this study. First, it had a retrospective design with a relatively small sample size. Second, it had a single design that precluded the generalisation of the findings. Third, we were unable to identify the aetiology of stroke and whether it was caused by thrombosis, embolism or hypoperfusion in each individual patient. Further large-scale, prospective studies are needed to confirm these findings. Conclusion Stroke is a major concern in elderly individuals who undergo open-heart surgery. It not only could result from cross-clamping, but there are also several factors playing a role in its aetiology. Existing data on stroke have yielded conflicting results regarding the use of the SCT and MCT. Therefore, the selection of alternative treatment methods, such as CABG on a beating heart, to be used on an individual basis, might reduce the stroke rate, particularly in elderly individuals. 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