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Transcranial and carotid Doppler study in coronary artery bypass graft patients
Mehdi Farhoudi1, Abbas Afrasiabi, Mohammad K Tarzamni
1Neurology Department, Imam Medical Center, Tabriz, Post Code 5159-47343, Iran. Tel. +98 (411) 3362346. Fax. +98 (411) 3342889.
Insights
Coronary artery bypass graft (CABG) patients often have intracranial and carotid artery stenosis. Transcranial Doppler (TCD) and carotid duplex studies can identify these conditions, aiding in preventing cerebrovascular accidents.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Atherosclerosis commonly affects both coronary and intracranial arteries.
- Coronary artery bypass graft (CABG) surgery patients are at risk for cerebrovascular events.
Purpose of the Study:
- To assess intracranial artery diseases using transcranial Doppler (TCD) and carotid artery diseases using carotid duplex studies in CABG patients.
- To identify correlations between coronary artery disease severity and intracranial/carotid artery abnormalities.
Main Methods:
- A prospective randomized study of 129 elective CABG patients.
- Preoperative TCD and carotid duplex examinations were performed.
- Neurologic examinations were conducted pre- and post-operatively.
Main Results:
- TCD revealed abnormalities in 23.2% of patients, including basilar artery stenosis (5.4%) and middle cerebral artery stenosis (2.3%).
- Carotid duplex studies showed abnormalities in 51.1% of patients, with significant stenosis (>70%) in 2%.
- Significant correlations were found between coronary artery disease severity and abnormalities detected by TCD (p=0.008) and carotid duplex (p<0.01).
- TCD abnormalities were more prevalent in female (p=0.008) and hypertensive (p=0.004) patients.
Conclusions:
- Intracranial and carotid artery stenosis is common in CABG patients, particularly those with multi-vessel coronary disease, hypertension, or female patients.
- Recommend TCD and carotid duplex screening for CABG patients to prevent cerebrovascular accidents.
Objective:
Atherosclerosis is a pathogenesis which is common in both coronary and intracranial arterial diseases. Therefore, we designed a group of coronary artery bypass graft (CABG) surgery patients for transcranial Doppler (TCD) to assess intracranial artery diseases and carotid duplex studies to assess carotid artery diseases.
Methods:
In a prospective randomized study, 129 elective CABG patients with proven coronary artery disease by angiography, were examined by TCD and 45 patients by carotid duplex preoperatively. Neurologic examination was carried out pre- and post- operatively. This study was carried out from April 2001 to August 2002 at Imam Hospital of Tabriz Medical Science University, Iran.
Results:
Out of the 129 CABG patients, there were 105 males and 24 females, with an average age of 57+\-9.9 years. Risk factors were as follows: smoking in 44.8%, hypertension in 38%, hypercholesterolemia in 29%, and diabetes mellitus in 18.6%. The TCD findings of 30 patients (23.2%, 11 female and 19 male) revealed the following abnormalities: stenosis of basilar artery in 7 patients (5.4%), carotid siphon in 3 (2.3%), intracranial internal carotid in 5 (3.9%), middle cerebral artery in 3 (2.3%) and vertebral artery in one patient (0.8%). Multiple vessel abnormality was detected in 11 patients (8.5%). There was a significant correlation between severity of coronary artery disease in angiography and abnormality in TCD (p=0.008). The TCD abnormality was detected more in females (p=0.008) or hypertensive patients (p=0.004). In the carotid duplex study of the randomized 45 patients, 23 (51.1%) had abnormal results as follows: stenosis <50% in 17 (38%) cases, stenosis between 50-70% in 5 (11%), and hemodynamically significant stenosis (>70%) only in one (2%) patient. There was also significant correlation between severity of coronary involvement and carotid involvement (p<0.01). No stroke occurred in the first postoperative week following CABG surgery.
Conclusion:
Stenosis of intracranial and carotid arteries was more common in CABG patients with more than 2-coronary vessel involvement or hypertensive or female patients. We recommend TCD and carotid duplex studies in these patients for prevention of probable cerebrovascular accidents.
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