Objectives: Significant internal carotid artery (ACI) is associated with the increased perioperative
stroke rate in patients undergoing coronary artery bypass grafting (CABG). The optimal
management of patients undergoing CABG with concomitant significant carotid artery
stenosis remains controversial. The aim of our study was to investigate whether OPCAB
surgery can reduce the perioperative stroke rate in patients with severe asymptomatic
ACI stenosis when compared with on-pump CABG (ONCAB).
Methods: We have performed a retrospective data-base analysis of patients undergoing isolated
CABG operated between July 2009 and October 2018. A total of 10,613 patients were
included of which 243 patients had confirmed severe ACI stenosis without history of
stroke. The patients with severe ACI stenosis were allocated in two groups based on
the surgical technique used (ONCAB = 92) vs. OPCAB = 151). To correct for the baseline
differences, we performed matched propensity score analysis considering 25 baseline
characteristics what resulted in 78 pairs.
The primary outcome was perioperative stroke rate. The secondary outcomes were all
cause in-hospital mortality, postoperative delirium, intensive care unit (ICU) and
hospital length of stay.
Result:
|
Outcomes
|
PS-matched sample (n = 156)
|
p
|
|
On-Pump (n = 78)
|
OPCAB (n = 78)
|
OR (95% CI)
|
|
Primary outcomePerioperative stroke
|
8 (10.3%)
|
1 (1.3%)
|
0.1 (0.01–0.9)
|
0.03
|
|
Secondary outcomesPostoperative delirium, n (%)
|
5 (6.4%)
|
8 (10.3%)
|
1.7 (0.5–3.7)
|
0.39
|
|
In-hospital mortality, n (%)
|
3 (3.8%)
|
3 (3.8%)
|
1.0 (0.2–5.1)
|
1.00
|
|
ICU stay (days)
|
1.0 (3.1–0.3)
|
1.0 (2.7–8.9)
|
1.0 (0.9–1.1)
|
0.94
|
|
Hospital stay (days)
|
13.0 (13.8–18.4)
|
12 (13.4–19.0)
|
1.0 (0.9–1.1)
|
0.51
|
Conclusion: OPCAB surgery significantly reduced perioperative stroke rate in patients with severe
asymptomatic ACI stenosis. OPCAB surgery may be considered as the technique of choice
for patients with severe asymptomatic ACI stenosis undergoing isolated CABG.
