Related Experiment Videos
The risk of perioperative stroke in patients with asymptomatic carotid bruits undergoing peripheral vascular surgery
Insights
Asymptomatic carotid bruits in patients undergoing vascular surgery indicate a high risk for perioperative stroke. Hemodynamic evaluation is crucial for identifying significant bruits and managing stroke risk.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Peripheral vascular procedures carry risks, including perioperative stroke.
- Asymptomatic carotid bruits are common and their significance in surgical risk is not fully understood.
Purpose of the Study:
- To evaluate the incidence of asymptomatic carotid bruits in patients undergoing elective peripheral vascular procedures.
- To determine the hemodynamic significance of these bruits using the GEE-OPG.
- To assess the association between hemodynamically significant carotid bruits and perioperative stroke risk.
Main Methods:
- Preoperative screening for carotid bruits in 300 patients undergoing 374 vascular procedures.
- Hemodynamic evaluation of identified bruits using the GEE-OPG (oculopneumoplethysmography).
- Analysis of perioperative stroke incidence based on bruit presence and hemodynamic significance.
Main Results:
- 74 patients (24.7%) had 118 carotid bruits.
- 25 bruits (22.3%) were hemodynamically significant based on GEE-OPG.
- Overall perioperative stroke incidence was 0.8% (3/374).
- Stroke incidence was 16% (3/19) in patients with hemodynamically significant bruits, versus 0% in others.
Conclusions:
- A subgroup of patients with hemodynamically significant carotid bruits faces a substantially elevated risk of perioperative stroke.
- Preoperative identification and hemodynamic assessment of carotid bruits are vital for risk stratification in vascular surgery patients.
Abstract:
Three hundred patients without neurologic symptoms had 374 elective peripheral vascular procedures and they were screened preoperatively for incidental asymptomatic carotid bruits prior to surgery. The bruits were hemodynamically evaluated with the GEE-OPG. A bruit was considered hemodynamically significant if the OPG test was positive. Seventy-four patients (24.7%, 74/300) were found to have 118 carotid bruits. Twenty-five (22.3%, 25/112) of the 112 bruits with OPG studies were hemodynamically significant. There were three perioperative strokes that occurred for an incidence of 0.8 per cent (3/374). There was no stroke in patients without bruits and with nonhemodynamically significant bruits. The incidence of perioperative stroke in patients with hemodynamically significant bruits was 16 per cent (3/19). There is a subgroup of patients with hemodynamically significant carotid bruits who are at high risk for perioperative stroke.