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

Abstract

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.

Stroke associated with coronary artery bypass grafting

“…Various studies have identified patientspecific risk factors for stroke associated with CABG as follows: prior stroke or transient ischemic attack [2,13,14], carotid artery stenosis [15][16][17][18], aortic atherosclerosis [19,20], atrial fibrillation [3,21], peripheral arterial disease [21], prior cardiac surgery [22], poor baseline clinical condition [3,23], left ventricular dysfunction [21], prolonged time on cardiopulmonary bypass (CPB) [21,22], conventional onpump CABG [22] and older age [2,3]. The presence of any one risk factor for stroke is not considered a contraindication [13].…”

“…The incidence of stroke has been reported to be high in patients with carotid stenosis who undergo CABG [15][16][17][18]. One study showed that patients with 50-99 % stenosis or occlusion incurred 7 % stroke risk, increasing to 9 % in those with 80-99 % stenosis or occlusion [16].…”

“…Several studies showed that asymptomatic carotid stenosis was not an independent risk factor for ipsilateral carotid territory ischemic stroke with CABG [15,17]. One study compared 117 patients who had severe (C75 %) asymptomatic carotid stenosis with 761 patients who did not have severe carotid stenosis [17].…”

“…One study compared 117 patients who had severe (C75 %) asymptomatic carotid stenosis with 761 patients who did not have severe carotid stenosis [17]. Both groups had similar rates of in-hospital stroke (3.4 vs. 3.6 %).…”

Letter by Weimar and Knipp Regarding Article, “Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery”

“…We read with great interest the article by Mahmoudi et al 1 In this retrospective analysis of 878 consecutive patients undergoing coronary artery bypass graft (CABG) surgery, the authors found similar perioperative stroke rates and mortality in 117 patients with Ն75% asymptomatic carotid artery stenosis (CAS) compared with 761 patients without severe CAS. The authors conclude that these results argue against routine synchronous carotid intervention in patients with asymptomatic severe CAS undergoing CABG but that such an approach is indicated in a selected cohort of patients, such as those with the most severe disease in association with unstable cardiac symptoms and/or significant comorbidities.…”