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Myocardial revascularisation in patients with carotid artery disease
O A Adebo1, C N Lee, C A Mestres
1Department of Surgery, National University Hospital, Singapore.
Insights
Patients with carotid bruit or stroke history face higher stroke risk after coronary artery bypass graft (CABG). Carotid artery disease significantly elevates this risk, warranting further investigation into combined procedures.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coronary artery bypass graft (CABG) is a common procedure.
- Patients undergoing CABG may have co-existing cerebrovascular disease.
- Carotid bruit and transient ischemic attack/stroke history indicate potential cerebrovascular issues.
Purpose of the Study:
- To assess the stroke risk after CABG in patients with indicators of cerebrovascular disease.
- To determine the prevalence of carotid artery stenosis in this patient group.
- To evaluate the outcomes of combined carotid endarterectomy and CABG.
Main Methods:
- Retrospective analysis of 80 patients with carotid bruit/stroke history undergoing CABG (Group I).
- Comparison with 320 patients without cerebrovascular disease undergoing CABG (Group II).
- Digital subtraction angiography (DSA) used to assess carotid artery stenosis.
Main Results:
- Group I had a significantly higher postoperative stroke rate (13.2%) compared to Group II (0.63%).
- Carotid artery stenosis was present in 66% of Group I patients, with 15% having >70% occlusion.
- One stroke occurred in five patients who underwent combined carotid endarterectomy and CABG.
Conclusions:
- The risk of stroke post-CABG is elevated in patients with carotid bruit or stroke history.
- Established carotid artery disease further increases postoperative stroke risk.
- The role of combined carotid endarterectomy and CABG requires further study.
Abstract:
From January 1987 to December 1989, 80 patients with carotid bruit and/or history of transient ischaemic attack/stroke underwent digital subtraction angiography (DSA) prior to consideration for coronary artery bypass graft. Thirty-eight patients (Group I) out of the 80 had coronary artery bypass graft done with postoperative stroke in five (13.2%); this contrasted with a group of 320 patients (Group II) without cerebrovascular disease who underwent coronary artery bypass graft during the same period with postoperative stroke in two cases (0.63%) (p less than 0.0005). Carotid artery stenosis was noted on the DSA in 66% of Group I patients, with significant disease (greater than 70% occlusion) in 15%, while the study was normal in 34% of cases. Combined carotid endarterectomy and coronary artery bypass graft was done in five of Group I patients, with postoperative stroke in one; this was the only one among the stroke patients with significant carotid disease. All strokes, except in one patient, resolved within one to 6 1/2 months. These results suggest that the risk of stroke after coronary artery bypass graft is increased in patients with carotid bruit or history of transient ischaemic attack/stroke and in the presence of established carotid artery disease. The place of combined carotid endarterectomy and coronary artery bypass graft in these cases remains to be determined.