Influence of carotid artery stenosis on stroke in patients undergoing off-pump coronary artery bypass grafting

Manabe, Susumu; Shimokawa, Tomoki; Fukui, Toshihiro; Fumimoto, Ken U.; Ozawa, Noritaka; Seki, Hiroshi; Ikenaga, Shigeru; Takanashi, Shuichiro

doi:10.1016/j.ejcts.2008.08.005

Cited by 39 publications

(33 citation statements)

References 21 publications

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“…Contrary to these studies, Manabe, et al 36) reported that the impact of carotid artery stenosis on the incidence of perioperative stroke may be little in OPCAB. They conducted a retrospective study of 461 patients who underwent elective OPCAB after screening for carotid artery stenosis.…”

Section: Diabetes Mellitus (Dm)mentioning

confidence: 77%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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Off-pump coronary artery bypass grafting (OPCAB) is performed in about 65% of patients who require surgical coronary revascularization, and has become the standard procedure in coronary artery bypass grafting (CABG) in Japan. As a background of the high rate of OPCAB, many clinical and experimental studies have been performed and reported in Japan. In this review, several factors associated with OPCAB are discussed based on relevant and important clinical studies published in Japan in the English language.

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Section: Diabetes Mellitus (Dm)mentioning

confidence: 77%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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“…[23][24][25] In their retrospective study of 461 patients who underwent elective off-pump CABG after screening for CAS, Manabe et al 23 identified no significant differences in the incidence of stroke or mortality in those with and without significant CAS. Similarly, in their analysis of 61 consecutive patients undergoing cardiac surgery who were found to have unilateral, asymptomatic 70% to 99% CAS, Baiou et al 24 found that no patient had experienced a stroke in the perioperative period whereas 4.9% had died within 30 days of surgery, all as a consequence of myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Mahmoudi

Hill

Zhang

et al. 2011

Stroke

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Background and Purpose— Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain. Methods— A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed. Patients with severe CAS (n=117) were compared with those without severe CAS (n=761) to assess the rates of stroke and mortality during hospitalization for CABG. The 30-day mortality rate was also assessed. Results— Patients with severe CAS were older and had a higher prevalence of peripheral arterial disease and heart failure. Patients with severe CAS had similar rates of in-hospital stroke (3.4% versus 3.6%; P =1.0) and mortality (3.4% versus 4.2%; P =1.0) compared with patients without severe CAS. The 30-day rate of mortality was also similar between the 2 cohorts (3.4% versus 2.9%; P =0.51). Conclusions— Severe CAS alone is not a risk factor for stroke or mortality in patients undergoing CABG. The decision to perform carotid imaging and subsequent revascularization in association with CABG must be individualized and based on clinical judgment.

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“…2,3 Mechanisms associated with post-CABG stroke include embolic, 4 hypoperfusion and air/fat embolism. 5 In many patients, coronary artery disease (CAD) represents but one manifestation of diffuse vascular disease; it is often found concomitantly among patients with atherosclerotic cerebrovascular disease. 6 Hemodynamically significant internal carotid artery stenosis detected prior to cardiac surgery has been managed by combined or sequential carotid endarterectomy (CEA) 7,8 or, more recently, with carotid artery stenting (CAS) 9 to decrease the potential for post-surgical stroke.…”

Section: Introductionmentioning

confidence: 99%

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

et al. 2009

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Carotid duplex ultrasonography (DUS) is routinely performed prior to coronary artery bypass graft surgery (CABG) on all patients > 65 years old because of the reported associated risk of finding concomitant carotid artery stenosis. Identifying risk factors that correlate with severe carotid stenosis may result in more costeffective screening for patients with asymptomatic carotid artery disease prior to CABG. We performed a retrospective study to identify risk factors for significant carotid artery disease in patients scheduled to undergo CABG between March 2005 and March 2008 at the Massachusetts General Hospital. Patients with carotid stenosis ≥ 70% identified by DUS (n = 50) were matched by age and sex to control patients who had < 50% stenosis (n = 50). Data were analyzed using the chi-squared test or analysis of variance as appropriate. Logistic regression was used to examine multivariate correlates of carotid stenosis. A total of 643 patients were screened to arrive at the patient cohorts described below. This produced a prevalence of 7.7% for significant (> 70%) carotid disease. The patient cohorts were predominantly male with no significant difference in the incidence of diabetes, hypertension, extent of coronary artery disease (CAD) (i.e. left main coronary artery disease (LMCA) and one, two-, or three-vessel CAD) or lipid abnormalities in the two groups. Univariate analysis identified the presence of peripheral arterial disease (PAD, p = 0.001), a cervical bruit (p < 0.0001), a prior neurological event (p = 0.020), and the presence of an abdominal aortic aneurysm (AAA; p = 0.046) as significant predictors of ≥ 70% internal carotid artery stenosis. Logistic regression analysis revealed that the presence of a carotid bruit (p = 0.0068) and PAD (p = 0.0194) were associated with an increased risk of significant carotid artery disease. In conclusion, the presence of a carotid bruit or PAD predicts an increased likelihood of significant carotid artery disease in patients undergoing CABG. Unlike previous studies, LMCA or extent of CAD did not correlate with significant carotid artery disease. Using these predictive models, a prospective outcomes trial is required to validate these criteria.

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Influence of carotid artery stenosis on stroke in patients undergoing off-pump coronary artery bypass grafting

Abstract: The influence of carotid artery stenosis on the incidence of perioperative stroke may be little in off-pump CABG, especially in patients with moderate carotid artery stenosis.

Cited by 39 publications

References 21 publications

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

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