Postoperative stroke in cardiac and peripheral vascular disease
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Physical exams are unreliable for detecting carotid artery disease severity. Noninvasive tests revealed severe lesions in some patients, but postoperative stroke rates were similar between coronary artery and peripheral vascular disease patients, regardless of bruits or stenosis.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid artery disease is a significant risk factor for perioperative stroke.
- Physical examination findings like bruits are often unreliable indicators of carotid stenosis severity.
- Noninvasive screening methods are crucial for assessing carotid lesions before vascular surgery.
Purpose of the Study:
- To evaluate the prevalence and significance of carotid lesions in patients undergoing coronary artery (CAD) and peripheral vascular surgery (PVD).
- To determine the relationship between carotid bruits, noninvasive screening results, and postoperative stroke incidence.
- To assess the accuracy of physical examination in identifying severe carotid disease.
Main Methods:
- Compared postoperative stroke rates in 330 patients (170 CAD, 160 PVD) with carotid bruit presence and noninvasive screening results (Doppler imaging, spectral analysis).
- Identified high-grade stenosis or occlusion in 62 PVD and 14 CAD patients via noninvasive tests.
- Uncovered severe, occult carotid lesions in 13 patients (9 PVD, 4 CAD).
Main Results:
- Postoperative neurologic complications occurred in 16 patients (13 strokes, 3 TIAs).
- Most complications (13) occurred in patients with normal or nonstenotic carotids; only 4 occurred in patients with bruits and stenosis.
- Severe carotid stenosis was more common in PVD than CAD patients, but postoperative stroke rates did not differ significantly.
Conclusions:
- Physical examination is inaccurate for assessing carotid disease severity.
- Noninvasive screening is valuable for detecting significant carotid lesions.
- No direct correlation was found between carotid bruits, disease severity, and perioperative stroke incidence.
Abstract:
The postoperative stroke rate in 330 patients requiring coronary artery (170) or peripheral vascular (160) surgery was compared with the presence of carotid bruits and the results of noninvasive screening (Doppler imaging and spectral analysis of flow) to determine prevalence and significance of carotid lesions) and their relationship to perioperative stroke. Carotid lesions were suspected because of bruits in 70 patients with peripheral vascular disease (PVD) and in 28 patients with coronary artery disease (CAD). Noninvasive tests showed high grade stenosis or occlusion in 62 patients with PVD and in 14 with CAD. Forty-four patients with PVD and 101 patients with CAD had normal Doppler studies. The rest in both groups had plaquing without major stenosis. Noninvasive tests uncovered severe, occult lesions in only 13 patients (9 PVD, 4 CAD). Postoperative neurologic complications occurred in 16 patients (13 strokes: 5 PVD, 8 CAD and 3 TIAs: 2 PVD, 1 CAD). Thirteen neurologic complications occurred in patients having nonstenotic plaques or normal carotids without bruits. Only three of the strokes and 1 TIA occurred in patients with bruits and detectable carotid stenosis. Few of the postoperative strokes or TIAs were focal (2 PVD, 1 CAD), and the rest were nonfocal. None of the postoperative strokes or TIAs were associated with postoperative carotid occlusion. Physical examination is not an accurate method of determining severity of carotid disease. Severe carotid stenosis is more common in PVD patients than in CAD patients, but there is no significant difference in postoperative stroke rate. No direct relationship has been found between a bruit, severity of disease, and incidence of perioperative stroke.