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Carotid disease is a risk factor for stroke in coronary bypass operations
C L Birincioğlu1, M Bayazit, A T Ulus
1Department of Cardiovascular Surgery at Türkiye Yüksek Ihtisas Hospital, Ankara.
Insights
Prophylactic carotid endarterectomy effectively prevents major cerebrovascular events in high-risk coronary artery bypass grafting patients. The "pump off" technique also reduces event risk, especially for moderate carotid stenosis.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) carries a risk of perioperative major cerebrovascular events (MCVEs).
- Identifying patients at high risk for MCVEs is crucial for developing effective preventive strategies.
Purpose of the Study:
- To investigate the risk of perioperative MCVEs in patients undergoing CABG.
- To evaluate preventive therapies for MCVEs in this population.
Main Methods:
- A cohort of 722 patients undergoing CABG with carotid artery duplex scanning (CADS) was studied.
- Patients with specific conditions like severe aortic atheromas or combined intracardiac procedures were excluded.
- Risk factors for MCVEs were analyzed, including carotid artery stenosis severity.
Main Results:
- Advanced age, smoking, prior MCVE, and severe coronary artery disease correlated with high-grade (80-99%) carotid stenosis.
- MCVEs were associated with carotid stenosis > 60% and reduced cardiac output requiring inotropic support.
- Prophylactic carotid endarterectomy (CEA) significantly reduced MCVE incidence in patients with 80-99% stenosis (p < 0.01).
- The "pump off" technique, compared to standard cardiopulmonary bypass, decreased MCVE incidence (p = 0.056).
Conclusions:
- Prophylactic CEA is effective in preventing perioperative MCVEs for patients with 80-99% carotid stenosis undergoing CABG.
- The "pump off" technique is beneficial in reducing MCVEs for patients with 60-79% carotid stenosis.
Abstract:
The purpose of this study was to investigate the risk of perioperative major cerebrovascular events (MCVEs) in patients undergoing coronary artery bypass grafting (CABG) and to develop preventive therapy. After excluding the patients with marked ascending aortic atheromas and those with combined intracardiac procedures such as valve replacement and aneurysmectomy, 722 consecutive patients who had carotid artery duplex scanning (CADS) and CABG were studied. The results of the study showed the correlation of advanced age, smoking, previous major cerebrovascular event (MCVE), and severe coronary artery disease with high grade carotid artery stenosis of 80-99% (p < 0.05). A total of 13 patients had perioperative MCVE and an analysis of risk factors showed that the MCVE correlated with carotid stenosis of > 60% and reduced cardiac output requiring inotropic support (p < 0.01). Prophylactic carotid endarterectomy (CEA) in patients with 80% to 99% carotid stenosis notably decreased the incidence of MCVE (p < 0.01), and the use of the "pump off" technique instead of standard cardiopulmonary bypass decreased MCVE (p = 0.056). On the basis of these data, prophylactic carotid endarterectomy is effective in averting perioperative MCVE in subjects with carotid stenosis of 80% to 99%, and for those with 60% to 79% carotid stenosis, the pump off technique decreases MCVE.