Abstract
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: https://clinicaltrials.gov. Unique identifier: NCT02319083.
| Original language | English |
|---|---|
| Pages (from-to) | 741-748 |
| Number of pages | 8 |
| Journal | European Journal of Vascular and Endovascular Surgery |
| Volume | 56 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Nov 1 2018 |
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Keywords
- Carotid artery stenosis
- Coronary artery bypass grafting
- Stroke
ASJC Scopus subject areas
- Surgery
- Cardiology and Cardiovascular Medicine
Cite this
Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting. / Santarpino, Giuseppe; Nicolini, Francesco; De Feo, Marisa; Dalén, Magnus; Fischlein, Theodor; Perrotti, Andrea; Reichart, Daniel; Gatti, Giuseppe; Onorati, Francesco; Franzese, Ilaria; Faggian, Giuseppe; Bancone, Ciro; Chocron, Sidney; Khodabandeh, Sorosh; Rubino, Antonino S.; Maselli, Daniele; Nardella, Saverio; Gherli, Riccardo; Salsano, Antonio; Zanobini, Marco; Saccocci, Matteo; Bounader, Karl; Rosato, Stefano; Tauriainen, Tuomas; Mariscalco, Giovanni; Airaksinen, Juhani; Ruggieri, Vito G.; Biancari, Fausto.
In: European Journal of Vascular and Endovascular Surgery, Vol. 56, No. 5, 01.11.2018, p. 741-748.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting
AU - Santarpino, Giuseppe
AU - Nicolini, Francesco
AU - De Feo, Marisa
AU - Dalén, Magnus
AU - Fischlein, Theodor
AU - Perrotti, Andrea
AU - Reichart, Daniel
AU - Gatti, Giuseppe
AU - Onorati, Francesco
AU - Franzese, Ilaria
AU - Faggian, Giuseppe
AU - Bancone, Ciro
AU - Chocron, Sidney
AU - Khodabandeh, Sorosh
AU - Rubino, Antonino S.
AU - Maselli, Daniele
AU - Nardella, Saverio
AU - Gherli, Riccardo
AU - Salsano, Antonio
AU - Zanobini, Marco
AU - Saccocci, Matteo
AU - Bounader, Karl
AU - Rosato, Stefano
AU - Tauriainen, Tuomas
AU - Mariscalco, Giovanni
AU - Airaksinen, Juhani
AU - Ruggieri, Vito G.
AU - Biancari, Fausto
PY - 2018/11/1
Y1 - 2018/11/1
N2 - 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: https://clinicaltrials.gov. Unique identifier: NCT02319083.
AB - 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: https://clinicaltrials.gov. Unique identifier: NCT02319083.
KW - Carotid artery stenosis
KW - Coronary artery bypass grafting
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85052931575&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052931575&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2018.07.042
DO - 10.1016/j.ejvs.2018.07.042
M3 - Article
C2 - 30197287
AN - SCOPUS:85052931575
VL - 56
SP - 741
EP - 748
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 5
ER -