Giuseppe Santarpino1, Francesco Nicolini2, Marisa De Feo3, Magnus Dalén4, Theodor Fischlein5, Andrea Perrotti6, Daniel Reichart7, Giuseppe Gatti8, Francesco Onorati9, Ilaria Franzese10, Giuseppe Faggian9, Ciro Bancone3, Sidney Chocron6, Sorosh Khodabandeh4, Antonino S Rubino10, Daniele Maselli11, Saverio Nardella11, Riccardo Gherli12, Antonio Salsano13, Marco Zanobini14, Matteo Saccocci14, Karl Bounader15, Stefano Rosato16, Tuomas Tauriainen17, Giovanni Mariscalco18, Juhani Airaksinen19, Vito G Ruggieri20, Fausto Biancari21. 1. Cardiovascular Centre, Paracelsus Medical University, Nuremberg, Germany; Città di Lecce Hospital, GVM Care&Research, Lecce, Italy. 2. Division of Cardiac Surgery, University of Parma, Parma, Italy. 3. Department of Cardiothoracic and Respiratory Sciences, University of Campania, Naples, Italy. 4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. Cardiovascular Centre, Paracelsus Medical University, Nuremberg, Germany. 6. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 7. Hamburg University Heart Centre, Hamburg, Germany. 8. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 9. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 10. Centro Clinico-Diagnostico "G.B. Morgagni", Centro Cuore, Pedara, Italy. 11. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. 12. Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. 13. Division of Cardiac Surgery, University of Genoa, Genoa, Italy. 14. Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan, Milan, Italy. 15. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 16. National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy. 17. Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland. 18. Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK. 19. Heart Centre, Turku University Hospital, and University of Turku, Turku, Finland. 20. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 21. Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland; Heart Centre, Turku University Hospital, and University of Turku, Turku, Finland. Electronic address: faustobiancari@yahoo.it.
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.
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.
Authors: Fernando Bassan; Vitor M P Azevedo; Ana Angélica Alves Pimenta Santos; Renan Bernardes de Mello; Annelise de Almeida Verdolin; Roberto Bassan Journal: Braz J Cardiovasc Surg Date: 2022-05-23
Authors: Nicholas R Hess; Arman Killic; Derek R Serna-Gallegos; Forozan Navid; Yisi Wang; Floyd Thoma; Ibrahim Sultan Journal: JTCVS Open Date: 2021-07-10