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) |
Persistent link: | http://urn.fi/urn:nbn:fi-fe2019102134026 |
Language: | English |
Published: |
Elsevier,
2018
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Publish Date: | 2019-10-21 |
Description: |
AbstractObjectives: 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: https://clinicaltrials.gov. Unique identifier: NCT02319083. see all
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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 |
OADOI: | https://oadoi.org/10.1016/j.ejvs.2018.07.042 |
Type of Publication: |
A1 Journal article – refereed |
Field of Science: |
3126 Surgery, anesthesiology, intensive care, radiology |
Subjects: | |
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 http://creativecommons.org/licenses/by-nc-nd/4.0/. |
https://creativecommons.org/licenses/by-nc-nd/4.0/ |