Carotid Artery Disease as a Predictor of In-Hospital Postoperative Stroke After Coronary Artery Bypass Grafting From 1999 to 2011

Mehta, Amol; Choxi, Ravi; Gleason, Thomas G.; Wechsler, Lawrence R.; Jovin, Tudor G

doi:10.1053/j.jvca.2017.10.010

Cited by 16 publications

(6 citation statements)

References 43 publications

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“…However, there has been much debate on routine use of carotid doppler to diagnose significant carotid stenosis preoperatively, and this is not currently routinely used at our centre, although is used in selected cases. The prevalence of significant carotid stenosis in unselected patients is found to be low, and the incidence of stroke in patients with severe carotid stenosis is found to be too low to warrant widespread screening and is not recommended by current guidelines [9][10][11][12] . Some suggest selective screening (for example, patients >70 years with previous TIA/stroke) may be useful as there is some evidence that severe carotid stenosis is a significant predictor for perioperative stroke following cardiac surgery in these patients 13 .…”

Section: Discussionmentioning

confidence: 99%

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Karunanantham

Ali

Evans

et al. 2020

Preprint

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Background Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterise the incidence of stroke and analyse the impact of stroke on patient outcomes and survival. Methods A retrospective analysis was performed of patients with a CT-confirmed stroke diagnosis between 01/01/2015 and 31/03/2019 at a single centre. 2:1 propensity matching was performed to identify a control population. Results Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging 0.85% for CABG to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or TIA. Compared to the comparison group, patients experiencing post-operative stroke had a significantly prolonged period of ICU admission (8.0 vs 1.1 days p<0.001) and hospital length of stay (12.94 vs 8.0 days p<0.001). Patient survival was also inferior. In-hospital mortality was almost 3 times as high (17.0% vs 5.9%; p<0.001). Longer-term survival was also inferior on Kaplan-Meier estimation (p<0.001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group. Conclusion Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. The potential to reduce morbidity and mortality with the emergence of mechanical thrombectomy, demonstrates the need for clear links between cardiothoracic and stroke teams to support individuals affected by perioperative stroke.

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Section: Discussionmentioning

confidence: 99%

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Karunanantham

Ali

Evans

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, there has been much debate on routine use of carotid doppler to diagnose significant carotid stenosis preoperatively, and this is not currently routinely used at our center, although is used in selected cases. The prevalence of significant carotid stenosis in unselected patients is found to be low, and the incidence of stroke in patients with severe carotid stenosis is found to be too low to warrant widespread screening and is not recommended by current guidelines 9‐12 . Some suggest selective screening (for example, patients >70 years with previous TIA/stroke) may be useful as there is some evidence that severe carotid stenosis is a significant predictor for perioperative stroke following cardiac surgery in these patients 13 .…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of significant carotid stenosis in unselected patients is found to be low, and the incidence of stroke in patients with severe carotid stenosis is found to be too low to warrant widespread screening and is not recommended by current guidelines. [9][10][11][12] Some suggest selective screening (for example, patients >70 years with previous TIA/stroke) may be useful as there is some evidence that severe carotid stenosis is a significant predictor for perioperative stroke following cardiac surgery in these patients. 13 It is notable that even in studies describing preoperative carotid screening there is a low rate of carotid intervention even when severe stenosis are detected.…”

Section: Discussionmentioning

confidence: 99%

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Karunanantham

Ali

Evans

et al. 2020

Journal of Cardiac Surgery

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Background: Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterize the incidence of stroke and analyze the impact of stroke on patient outcomes and survival. Methods: A retrospective analysis was performed of patients with a computed tomography-confirmed stroke diagnosis between 1 January 2015 and 31 March 2019 at a single center. 2:1 propensity matching was performed to identify a control population. Results: Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging from 0.85% for coronary artery bypass grafting to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or transient ischemic attack. Compared to the comparison group, patients experiencing postoperative stroke had a significantly prolonged period of intensive care unit admission (8.0 vs 1.1 days P < .001) and hospital length of stay (12.94 vs 8.0 days P < .001). Patient survival was also inferior. In-hospital mortality was almost three times as high (17.0% vs 5.9%; P < .001). Longer-term survival was also inferior to Kaplan-Meier estimation (P < .001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group. Conclusion: Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. Efforts should focus on identifying strategies aimed at reducing the incidence, morbidity, and mortality of perioperative stroke following cardiac surgery.

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“…1 Both severe asymptomatic unilateral and bilateral carotid stenosis are independent risk factors for in-hospital postoperative strokes following coronary artery bypass graft surgery (CABG). 2 Large studies of similar patient populations found no difference in stroke and death between staged and synchronous carotid intervention and CABG. 3,4 One meta analysis of 44,895 patients, however, found a statistically significant lower risk of myocardial infarction but a higher risk of stroke and death for synchronous procedures.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Staged TCAR and Cardiac Surgery or Structural Heart Intervention

Almenoff

Garrett

2021

Vasc Endovascular Surg

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Introduction: The optimal treatment strategy for patients with concomitant carotid and cardiac disease remains controversial. Transcarotid artery revascularization stenting with reversed flow protection (TCAR) has achieved results equivalent to carotid endarterectomy (CEA) in high risk patients. Methods: A retrospective review of all patients at a single center who received staged TCAR prior to cardiac intervention was performed. Results: 37 patients underwent 42 TCAR procedures prior to cardiac intervention (25 requiring open cardiac surgery and 12 requiring percutaneous intervention). There were no myocardial or neurological complications following TCAR prior to cardiac intervention. Three patients (8%) developed a neck hematoma which required evacuation. Conclusion: A staged approach to combined carotid and cardiac pathology with TCAR prior to cardiac intervention appears to be a safe and effective strategy.

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Carotid Artery Disease as a Predictor of In-Hospital Postoperative Stroke After Coronary Artery Bypass Grafting From 1999 to 2011

Cited by 16 publications

References 43 publications

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Evaluation of Staged TCAR and Cardiac Surgery or Structural Heart Intervention

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