Asymptomatic carotid artery stenosis and stroke risk in patients undergoing CABG
Leo Pölzl1, Ronja Lohmann1, Christian Sutter1
1Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Severe asymptomatic carotid artery stenosis (CAS) and prior stroke history significantly increase the risk of perioperative stroke and mortality following coronary artery bypass grafting (CABG) surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Perioperative stroke is a serious complication of coronary artery bypass grafting (CABG).
- Identifying patients at risk for stroke during CABG is crucial for improving surgical outcomes.
- Asymptomatic carotid artery stenosis (CAS) is a potential risk factor for perioperative stroke.
Purpose of the Study:
- To analyze the association between different degrees of asymptomatic CAS and perioperative outcomes in CABG patients.
- To identify predictors of perioperative ischemic stroke in patients undergoing CABG.
- To evaluate the impact of CAS on 30-day and 5-year mortality after CABG.
Main Methods:
- A cohort of 2727 patients undergoing isolated CABG between 2010 and 2020 was analyzed.
- Carotid stenosis severity was assessed using sonography for both internal carotid arteries.
- Cox regression analysis, adjusted for EuroSCORE II, was used to identify risk factors for stroke and mortality.
Main Results:
- Patients with CAS >90% exhibited significantly higher 30-day mortality (p<0.001) and increased incidence of postoperative stroke (p=0.005).
- A history of prior stroke was a strong independent predictor of perioperative stroke, with a hazard ratio of 6.829 (p<0.001).
- The incidence of 30-day stroke and mortality was 1.0% and 1.6%, respectively.
Conclusions:
- Asymptomatic carotid artery stenosis greater than 90% is an independent risk factor for perioperative stroke and 30-day mortality after CABG.
- A history of stroke is also an independent predictor of adverse perioperative outcomes in CABG patients.
- These findings highlight the importance of assessing carotid artery status in patients undergoing CABG.
Objective:
Perioperative stroke associated with coronary artery bypass grafting (CABG) is a catastrophic event. Identification of patients at risk and reduction of its incidence remains of high importance. The aim of this study was to analyse the association of different degrees of asymptomatic carotid artery stenosis (CAS) with the perioperative outcome in a consecutive series of CABG patients and to identify predictors for CABG associated ischaemic stroke.
Methods:
In total, 2727 patients undergoing isolated CABG procedure at the Medical University of Innsbruck between 2010 and 2020 were included in this study. Sonography data included the severity of carotid stenosis for left and right internal carotid artery individually. The primary outcome was the 30-day stroke and mortality rate, and the secondary outcome was 5-year mortality. A Cox regression model was performed after adjustment for EuroSCORE II.
Results:
Left CAS>50% was present in 177 patients (7%) and right CAS>50% in 197 patients (7.8%). In total, 1.6% (40 patients) of the patients died within 30 days after surgery, and 1.0% (24 patients) experienced a postoperative stroke within 30 days. Patients with a carotid stenosis>90% had a higher 30-day mortality (p<0.001) and higher incidence of postoperative stroke within 30 days (p=0.005). Patients with a history of a prior stroke were at higher risk of experiencing another stroke within 30-days after surgery, with an HR of 6.829 (2.811-16.589) (p<0.001).
Conclusions:
Asymptomatic CAS>90% and history of stroke are both independent risk factors for perioperative stroke and 30-day mortality.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:23Atherosclerosis IV: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease I: Introduction
01:27Angina II: Classification
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management