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Carotid and aortic screening for coronary artery bypass grafting
1Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Ibaraki, Japan. fukuda@tmch.or.jp
Insights
Preexisting carotid and aortic disease is common in coronary artery bypass grafting (CABG) candidates. Screening for these conditions can help tailor surgical strategies and reduce stroke risk.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery bypass grafting (CABG) patients often have coexisting carotid and aortic disease.
- Identifying risk factors for these conditions is crucial for surgical planning.
Purpose of the Study:
- To determine the prevalence of carotid artery stenosis and ascending aortic atherosclerosis in patients undergoing elective isolated CABG.
- To identify independent risk factors associated with these vascular diseases in the CABG population.
Main Methods:
- A cohort of 308 consecutive patients undergoing elective isolated CABG were evaluated.
- Preoperative duplex scanning of carotid arteries, chest CT, and intraoperative ultrasonography of the ascending aorta were performed.
- Multivariate analysis was used to identify significant risk factors.
Main Results:
- Prevalence rates were 14.3% for carotid stenosis and 30.2% for ascending aortic atherosclerosis.
- Independent risk factors for carotid stenosis included ascending aortic atherosclerosis, peripheral vascular disease, and history of stroke.
- Independent risk factors for ascending aortic atherosclerosis included peripheral vascular disease, age >60 years, and carotid stenosis.
- Operative modifications were made in 49 patients; hospital mortality and stroke morbidity were low (0.97% and 0.65%, respectively).
Conclusions:
- Carotid and aortic disease are prevalent in CABG candidates.
- Preoperative screening for carotid and aortic disease can inform surgical strategy modifications.
- Screening may help reduce the morbidity associated with stroke in CABG patients.
Background:
To identify risk factors for preexisting carotid and aortic disease in coronary artery bypass grafting (CABG), preoperative parameters were analyzed.
Methods:
Three-hundred eight consecutive patients undergoing elective isolated CABG were investigated through preoperative duplex scanning of the carotid artery, computed tomography of the chest, and intraoperative ultrasonography of the ascending aorta.
Results:
Prevalence of carotid stenosis and ascending aortic atherosclerosis was 14.3% (44 of 308) and 30.2% (93 of 308), respectively. Multivariate analysis indicated that significant independent risk factors for carotid stenosis were atherosclerosis of the ascending aorta (p = 0.028, odds ratio [OR] = 2.16), peripheral vascular disease (p = 0.008, OR = 4.08), and history of stroke (p = 0.0004, OR = 3.73). Significant independent risk factors for ascending aortic atherosclerosis were peripheral vascular disease (p = 0.029, OR = 3.05), age older than 60 years (p = 0.009, OR = 2.94), and carotid stenosis (p = 0.018, OR = 2.27). Modifications on the operative procedure for aortic atherosclerosis were carried out in 49 patients. Overall hospital mortality and morbidity for stroke were 0.97% and 0.65%, respectively.
Conclusions:
Prevalence of carotid and aortic disease was not low among candidates for CABG. Carotid and aortic screening may help to modify the operative strategy to reduce morbidity of stroke.