University of Oulu

Giuseppe Santarpino, Francesco Nicolini, Marisa De Feo, Magnus Dalén, Theodor Fischlein, Andrea Perrotti, Daniel Reichart, Giuseppe Gatti, Francesco Onorati, Ilaria Franzese, Giuseppe Faggian, Ciro Bancone, Sidney Chocron, Sorosh Khodabandeh, Antonino S. Rubino, Daniele Maselli, Saverio Nardella, Riccardo Gherli, Antonio Salsano, Marco Zanobini, Matteo Saccocci, Karl Bounader, Stefano Rosato, Tuomas Tauriainen, Giovanni Mariscalco, Juhani Airaksinen, Vito G. Ruggieri, Fausto Biancari, Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting, European Journal of Vascular and Endovascular Surgery, Volume 56, Issue 5, 2018, Pages 741-748, ISSN 1078-5884,

Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting

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Author: Santarpino, Giuseppe1,2; Nicolini, Francesco3; De Feo, Marisa4;
Organizations: 1Cardiovascular Centre, Paracelsus Medical University, Nuremberg, Germany
2Città di Lecce Hospital, GVM Care&Research, Lecce, Italy
3Division of Cardiac Surgery, University of Parma, Parma, Italy
4Department of Cardiothoracic and Respiratory Sciences, University of Campania, Naples, Italy
5Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
6Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
7Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
8Hamburg University Heart Centre, Hamburg, Germany
9Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
10Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
11Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy
12Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
13Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
14Division of Cardiac Surgery, University of Genoa, Genoa, Italy
15Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan, Milan, Italy
16Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
17National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
18Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
19Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
20Heart Centre, Turku University Hospital, and University of Turku, Turku, Finland
21Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-10-21


Objectives: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG).

Methods: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included.

Results: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50–59%, 6.0% of 60–69%, 3.1% of 70–79%, 1.4% of 80–89%, 0.5% of 90–99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50–59%, 1.0%; 60–69%, 0.6%; 70–79%, 1.2%; 80–89%, 5.1%; 90–99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90–99% (OR 12.03, 95% CI 1.34–108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820–42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta.

Conclusions: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified. Clinical Trial registration: Unique identifier: NCT02319083.

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Series: European journal of vascular and endovascular surgery
ISSN: 1078-5884
ISSN-E: 1532-2165
ISSN-L: 1078-5884
Volume: 56
Issue: 5
Pages: 741 - 748
DOI: 10.1016/j.ejvs.2018.07.042
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license