Risk Factors for Carotid Artery Stenosis in Chinese Patients Undergoing Coronary Artery Bypass Graft Interventions

Abstract

Current guidelines established in the USA and Europe for coronary artery bypass graft (CABG) suggest that patients ≥65 and ≥70 years of age, or with certain atherosclerotic-risk factors, should be screened preoperatively for extracranial carotid artery stenosis (CAS) to assess their risk of perioperative stoke. We sought factors that should be taken into consideration when treating Chinese CABG patients using CABG guidelines based on an analysis of CAS in a large cohort of Chinese CABG patients.We analyzed data for 1558 Chinese CABG patients who were screened preoperatively for CAS using duplex ultrasonography at a single institution. We defined significant and severe CAS as ≥50% and ≥70% stenosis, respectively, in one or more common or internal carotid arteries. We investigated the prevalence of CAS, the incidence of perioperative stroke, and the risk factors for CAS in the CABG cohort.The prevalence of CAS in the CABG cohort was 21.2%. Multivariate stepwise logistic regression analysis showed that an age ≥50 years and a history of smoking (odds ratios = 8.36 and 1.83, respectively) were independent risk factors for CAS (P < 0.05 for both). The incidence of perioperative stroke among CABG patients with significant or severe CAS was significantly higher (2.4% and 2.9%, respectively) than in CABG patients with <50% stenosis (0.5%; P = 0.004 and 0.029, respectively).Chinese CABG patients with a history of smoking or ≥50 years of age should undergo preoperative screening for CAS to assess their risk of perioperative stroke.

Prevalence of carotid artery stenosis in ischaemic heart disease patients in Bangladesh

“…22,23 Furthermore, study by Durand et al also identified elderly age, female gender, PVD, prior stroke, left main coronary disease, multi-vessel CAD, hypertension, and DM as risk factors associated with significant carotid artery lesion, which is also similar to other published articles. 15,18,20–25…”

Prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease in a tertiary hospital in Malaysia

“…[16,17] Extracranial carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing CABG surgery. [18,19] Therefore, carotid assessment before CABG provides important information on the risk of stroke after CABG. [20]…”

Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened?

“…Additionally, carotid artery stenosis (CAS) accompanying coronary artery disease caused by atherosclerosis plays a role in the neurological complications that occur after coronary bypass surgery in adults [2]. Although atheroembolisms from the aortic arch play a more significant role than CAS in postoperative stroke, ≥ 70% carotid stenosis detected by Doppler ultrasonography is an independent predictor of serious aortic arch disease [3]. In addition to these etiological causes, independent from atheroembolism, the presence of extracranial CAS during coronary surgery results in cerebral hypoperfusion, thereby increasing the frequency of postoperative neurological phenomena [4].…”