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Early and late results in patients with carotid disease undergoing myocardial revascularization
R D Schultz1, A V Sterpetti, R J Feldhaus
1Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131.
Insights
Patients with carotid artery disease undergoing coronary artery bypass grafting (CABG) face higher operative mortality and reduced survival. Asymptomatic carotid disease increases late neurological deficit risk but not perioperative stroke risk.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Carotid artery disease is a significant comorbidity.
- The impact of asymptomatic carotid artery disease on CABG outcomes requires clarification.
Purpose of the Study:
- To evaluate the association between carotid artery disease and outcomes in patients undergoing CABG.
- To assess perioperative stroke risk, late neurological deficits, operative mortality, and survival rates.
Main Methods:
- Retrospective review of 1,360 patients undergoing CABG.
- Comparison of patient groups with and without carotid artery disease, including those with asymptomatic bruits.
- Utilized ultrasonic duplex scanning and ocular pneumoplethysmography to assess carotid stenosis.
- Follow-up ranged from 3 to 120 months.
Main Results:
- Patients with carotid artery disease had higher operative mortality compared to randomly selected controls (p < 0.05).
- Increased risk of late neurological deficits was observed in patients with carotid disease not undergoing endarterectomy (p < 0.01).
- Carotid artery disease was associated with lower survival rates (p < 0.01).
Conclusions:
- Asymptomatic carotid artery disease does not increase perioperative stroke risk in CABG patients.
- Patients with carotid artery disease undergoing CABG face an elevated risk of late neurological deficits.
- Carotid artery disease indicates associated severe conditions, leading to increased mortality and reduced life expectancy.
Abstract:
A ten-year review of 1,360 patients undergoing coronary artery bypass grafting (CABG) by the same surgeon was undertaken. Sixty-two patients with symptoms of coronary artery insufficiency underwent carotid endarterectomy prior to or at the time of CABG (Group I). Ninety-seven patients had asymptomatic carotid bruits but did not undergo carotid endarterectomy (Group II). Sixty of these patients were studied by ultrasonic duplex scanning or ocular pneumoplethysmography or both, and hemodynamically significant stenosis was detected in 50 (Group IIa). Group III included 80 patients without carotid artery disease matched with Group II for sex, age, and clinical status. Group IV consisted of 200 patients without carotid artery disease randomly selected from our series. Follow-up ranged from 3 to 120 months (median, 41 months). In patients with proven carotid artery disease (Groups I and IIa), operative mortality was greater than in the patients randomly selected (Group IV) (p less than 0.05) but similar to that in the matched Group III. Late neurological deficits were greater in patients with carotid disease not undergoing carotid endarterectomy (p less than 0.01). Patients with carotid artery disease had lower survival than Group IV patients (p less than 0.01) but similar survival to that in the matched Group III. This study suggests that (1) asymptomatic patients with carotid artery disease who undergo CABG are not at increased risk of perioperative stroke; (2) these same patients are at increased risk of late neurological deficit; and (3) carotid artery disease is an indirect sign of severe associated disease and therefore is associated with increased operative mortality and decreased life expectancy.