Abstract 15451: Carotid Stenosis in CABG-Patients: is There an Indication for Surgical Treatment?
Objective: Stroke after CABG-procedures is a rare but devastating complication that leads to excess morbidity and mortality. The role of a significant carotid stenosis in the pathogenesis of this complication should be examined critically.
Methods: We retrospectively analyzed the records of 4258 patients which underwent a CABG-procedure with extracorporeal circulation (ECC) between 2005 and 2010. 85 of these patients underwent a simultaneous CABG and carotid endarterectomy (CEA) procedure. Carotid duplex sonography and/or (CT-)angiography was performed in 3194 patients (75 %) preoperatively. Postoperative stroke was defined as persistent (>24 h) focal or multifocal neurologic deficits. All patients with postoperative strokes were evaluated by a neurologist including duplex sonography including CT- or MR-scans.
Results: Postoperative stroke occurred in 81 patients (1.9 %). Among these, 29 cases of strokes (36 %) were detected within 24 hours of operation and the other 64 % within the first 96 hours. 78 strokes were ischemic and 3 strokes were associated to hemorrhagia. 62 patients (76 %) were classified to have cardioembolic stroke, 8 patients had large vessel strokes (10 %), and 7 patients (8.6 %) had small-vessel stroke. In 4 patients stroke could not be classified to a complex comorbidity. Compared to the entire cohort, the subgroup of patients with significant carotid stenosis had a higher incidence of postoperative stroke (4.8 % vs. 1.4 %, p<0.05). A combined procedure (CABG + CEA) increased the risk of postoperative stroke compared to isolated CABG in patients with a similar degree of carotid stenosis (12.7 vs. 4.8 %, p<0.01).
Conclusions: There was a higher incidence of stroke in patients with significant carotid stenosis. However, there was no direct correlation between postoperative stroke and a deseased carotid artery. Simultaneous CABG-CEA-procedures were associated with an increased incidence of neurologic complications.
- © 2011 by American Heart Association, Inc.