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The evolution of carotid and coronary artery disease after operation for carotid stenosis
J B Ricco1, J B Gauthier, J P Richer
1Service de Chirurgie Viscérale et Vasculaire, Centre Hospitalier Regional et Universitaire, Poitiers, France.
Insights
Post-carotid artery surgery, regular cardiac and neurologic surveillance is crucial. This study highlights its value in monitoring patients for potential cardiac events and carotid artery restenosis, improving outcomes.
Area of Science:
- Vascular Surgery
- Cardiology
- Neurology
Background:
- Carotid artery stenosis poses a significant risk for stroke.
- Patients undergoing carotid artery surgery require comprehensive follow-up.
- Integrated cardiac and neurologic surveillance is essential for managing post-operative risks.
Purpose of the Study:
- To evaluate the effectiveness of combined cardiac and neurologic surveillance in patients after carotid artery surgery.
- To assess the incidence of major adverse cardiac and cerebrovascular events during long-term follow-up.
- To determine the value of monitoring for carotid restenosis and contralateral stenosis.
Main Methods:
- A computerized surveillance program tracked 278 patients undergoing carotid artery surgery.
- Follow-up investigations for carotid and coronary arteries were conducted every six months.
- Data collected included mortality, morbidity, cardiac events, and carotid artery status via duplex scanning and arteriograms.
Main Results:
- Combined postoperative neurologic mortality and morbidity was 1.7%.
- Actuarial survival and freedom from cerebrovascular accidents at 36 months were 94% and 95.8%, respectively.
- Significant rates of myocardial infarction (6% at 36 months), angina, and asymptomatic carotid restenosis (> or = 80%) were observed, necessitating further interventions.
Conclusions:
- Regular cardiac and neurologic surveillance significantly benefits patients post-carotid artery surgery.
- The study demonstrates the importance of monitoring for both cardiac events and carotid artery restenosis.
- Proactive management based on surveillance findings can prevent major vascular events.
Abstract:
We followed 278 consecutive patients undergoing carotid artery surgery between January 1985 and December 1989 using a computerized surveillance program file with automatic carotid and coronary artery follow-up investigations every six months. Combined postoperative neurologic mortality and morbidity was 1.7%. During the mean follow-up period of 30 months, 10 patients died, four due to myocardial infarction. Actuarial rates of survival and freedom from cerebral vascular accidents at 36 months were 94% and 95.8%, respectively. No fatalities due to cerebral vascular accidents occurred during follow-up. Eleven patients had myocardial infarction, an actuarial rate of 6% at 36 months; 18 patients experienced angina pectoris, while seven sustained silent electrical myocardial ischemia. Findings on myocardial angioscintiscans and coronary artery arteriograms led to four aortocoronary bypasses and seven percutaneous coronary artery dilatations. Duplex scanning documented three asymptomatic carotid restenoses of > or = 80%, which were operated upon, and 32 contralateral carotid artery stenoses ranging between 80% and 99%, 24 of which were asymptomatic. Twenty-eight patients underwent secondary contralateral carotid artery revascularization. No one with contralateral carotid artery stenosis < 80% experienced a carotid artery ischemic event. These results clearly show the value of cardiac and neurologic surveillance of patients operated on for carotid artery stenosis.