Postoperative stroke in cardiac and peripheral vascular disease

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.