Carotid Stenosis in Cardiac Surgery—No Difference in Postoperative Outcomes
06 October 2015
02 January 2016
23 February 2016 (eFirst)
Background Debate over revascularization of asymptomatic carotid stenosis before cardiac surgery is ongoing. In this study, we analyze cardiac surgery outcomes in patients with asymptomatic carotid stenosis at a single hospital.
Methods In this study, 1,781 patients underwent cardiac surgery from January 2012 to June 2013; 1,357 with preoperative screening carotid duplex were included. Patient demographics, comorbidities, degree of stenosis, postoperative complications, and mortality were evaluated. Chi-square test and logistic regression analysis were performed.
Results Asymptomatic stenosis was found in 403/1,357 patients (29.7%; 355 moderate and 48 severe). Patients with stenosis, compared with those without, were older (71.7 ± 11 vs. 66.3 ± 12 years; p < 0.01). Females were more likely to have stenosis (odd ratio, = 1.7; 95% confidence interval, 1.4–2.2); however, patients were predominantly male in both groups. There were no significant differences in the rates of mortality and postoperative complications, including stroke and transient ischemic attack (TIA). Postoperative TIA occurred in 3/1,357(0.2%); only one had moderate stenosis. Inhospital stroke occurred in 21/1,357 (1.5%) patients; stroke rates were 2.3% (8/355) with moderate stenosis and 2.1% (1/48) severe stenosis. There were 59/1,357 (4.3%) deaths; patients with stenosis had a mortality rate of 4.2% (17/403); however, no postoperative stroke lead to death. Multivariable logistic regression analysis with adjustment for age, gender, race, comorbidities, and postoperative complications did not show an impact of carotid stenosis on postoperative mortality and development of stroke after cardiac surgery.
Conclusion This study suggests that patients with asymptomatic carotid stenosis undergoing cardiac surgery are not at increased risk of postoperative complications and mortality; thus, prophylactic carotid revascularization may not be indicated.
- 1 Bernhard VM, Johnson WD, Peterson JJ. Carotid artery stenosis. Association with surgery for coronary artery disease. Arch Surg 1972; 105 (06) 837-840
- 2 Bilfinger TV, Reda H, Giron F, Seifert FC, Ricotta JJ. Coronary and carotid operations under prospective standardized conditions: incidence and outcome. Ann Thorac Surg 2000; 69 (06) 1792-1798
- 3 Durand DJ, Perler BA, Roseborough GS. , et al. Mandatory versus selective preoperative carotid screening: a retrospective analysis. Ann Thorac Surg 2004; 78 (01) 159-166 , discussion 159–166
- 4 Naylor AR, Mehta Z, Rothwell PM, Bell PR. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg 2002; 23 (04) 283-294
- 5 Berens ES, Kouchoukos NT, Murphy SF, Wareing TH. Preoperative carotid artery screening in elderly patients undergoing cardiac surgery. J Vasc Surg 1992; 15 (02) 313-321 , discussion 322–323
- 6 Liapis CD, Bell PRF, Mikhailidis D. , et al; ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009; 37 (4, Suppl) 1-19
- 7 Illuminati G, Ricco JB, Caliò F. , et al. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting. J Vasc Surg 2011; 54 (04) 993-999 , discussion 998–999
- 8 Hobson II RW, Weiss DG, Fields WS. , et al; The Veterans Affairs Cooperative Study Group. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993; 328 (04) 221-227
- 9 Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273 (18) 1421-1428
- 10 Brott TG, Halperin JL, Abbara S. , et al. Guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Catheter Cardiovasc Interv 2013; 81 (01) E76-E123
- 11 Hertzer NR, Young JR, Beven EG. , et al. Coronary angiography in 506 patients with extracranial cerebrovascular disease. Arch Intern Med 1985; 145 (05) 849-852
- 12 Kougias P, Kappa JR, Sewell DH. , et al. Simultaneous carotid endarterectomy and coronary artery bypass grafting: results in specific patient groups. Ann Vasc Surg 2007; 21 (04) 408-414
- 13 Sharma V, Deo SV, Park SJ, Joyce LD. Meta-analysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting. Ann Thorac Surg 2014; 97 (01) 102-109