Combining Carotid and Cardiac Procedures to Reduce Postoperative Stroke
Combining Carotid and Cardiac Procedures to Reduce Postoperative Stroke
Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, et al
Arch Neurol. 2009;66:1091-1096
Summary
The increased incidence of stroke after cardiac surgery among patients with carotid stenosis has led surgeons to consider combining carotid and cardiac procedures in selected patients. The goal of this retrospective cohort study was to critically evaluate the role of significant carotid stenosis in the pathogenesis of postoperative stroke after commonly performed, nonurgent cardiac surgery. At a single tertiary care hospital, 4335 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both were assessed for stroke incidence, subtype, and arterial territory.
Clinically definite stroke was diagnosed during the same admission in 1.8% of patients who had cardiac surgery. Of these strokes, only 5.3% were in a large-vessel territory, and most (76.3%) were not accompanied by significant carotid stenosis. Among strokes detected on computed tomography head scans, 60% were not confined to a single carotid artery territory. Clinical data suggested that stroke occurred without direct correlation to significant carotid stenosis in 94.7% of patients. Compared with patients who had a similar degree of carotid stenosis but who underwent cardiac surgery alone, those who had combined carotid and cardiac operations had greater risk for postoperative stroke (15.1% vs 0%; P = .004).
Viewpoint
Limitations of this study include retrospective design and use of a single center. Nonetheless, these findings in a large study sample suggest no direct causal relationship between significant carotid stenosis and postoperative stroke in patients undergoing cardiac surgery. In patients with asymptomatic carotid stenosis, combining carotid and cardiac procedures does not appear to reduce the incidence of postoperative stroke.
If an estimated 5000 combined carotid endarterectomies and cardiac surgical procedures are performed annually in the United States, avoiding these combined procedures alone could prevent nearly 500 postoperative strokes per year.
Abstract
Strokes After Cardiac Surgery and Relationship to Carotid Stenosis
Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, et al
Arch Neurol. 2009;66:1091-1096
Summary
The increased incidence of stroke after cardiac surgery among patients with carotid stenosis has led surgeons to consider combining carotid and cardiac procedures in selected patients. The goal of this retrospective cohort study was to critically evaluate the role of significant carotid stenosis in the pathogenesis of postoperative stroke after commonly performed, nonurgent cardiac surgery. At a single tertiary care hospital, 4335 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both were assessed for stroke incidence, subtype, and arterial territory.
Clinically definite stroke was diagnosed during the same admission in 1.8% of patients who had cardiac surgery. Of these strokes, only 5.3% were in a large-vessel territory, and most (76.3%) were not accompanied by significant carotid stenosis. Among strokes detected on computed tomography head scans, 60% were not confined to a single carotid artery territory. Clinical data suggested that stroke occurred without direct correlation to significant carotid stenosis in 94.7% of patients. Compared with patients who had a similar degree of carotid stenosis but who underwent cardiac surgery alone, those who had combined carotid and cardiac operations had greater risk for postoperative stroke (15.1% vs 0%; P = .004).
Viewpoint
Limitations of this study include retrospective design and use of a single center. Nonetheless, these findings in a large study sample suggest no direct causal relationship between significant carotid stenosis and postoperative stroke in patients undergoing cardiac surgery. In patients with asymptomatic carotid stenosis, combining carotid and cardiac procedures does not appear to reduce the incidence of postoperative stroke.
If an estimated 5000 combined carotid endarterectomies and cardiac surgical procedures are performed annually in the United States, avoiding these combined procedures alone could prevent nearly 500 postoperative strokes per year.
Abstract
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