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

8:06 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

Most coronary angiographers look at the carotids and vertebrals as well as the renal arteries also while doing coronary angiography on the pretext that these patients may have coexistent disease and may require treatment of these conditions prior to treating the corronary stenosis.
Similarly, most cardiac surgeons advice carotid endarterectomy or stenting prior to CABG for patients with significant carotid stenosis even if they are asymptomatic.
I have always doubted this policy and now there is a proof.
The authors of this paper must be congratulated for bucking the trend and proving that these patients these poor patients need not undergo another invasive and potentially fatal procedure unncessarily.



by Mahmoudi, M., Hill, P. C., Xue, Z., Torguson, R., Ali, G., Boyce, S. W., Bafi, A. S., Corso, P. J., Waksman, R.
Stroke 2011

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

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.




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