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Stenosis of Carotid Artery Not Usually Cause of Strokes After Cardiac Surgery: Presented at ISC

By Lexa W. Lee

NEW ORLEANS -- February 25, 2008 -- Most strokes following cardiac surgery are not related to carotid artery stenosis, according to a retrospective study presented here at the International Stroke Conference (ISC) 2008.

Severe carotid stenosis is known to increase the risk of stroke in the general population. Whether it also increases the risk of stroke during open-heart surgery (OHS) remains controversial. There is no consensus as to whether candidates for OHS should receive preoperative noninvasive carotid assessment, and whether revascularisation is warranted before surgery in patients with significant carotid stenosis.

Researchers led by Yuebing Li, MD, Neurologist, Lehigh Valley Hospital, Allentown, Pennsylvania, evaluated the incidence of significant preoperative carotid stenosis and postoperative stroke, as well as the association between the two.

The study, presented in a poster session on February 22, was a retrospective analysis of 3,196 patients receiving nonurgent coronary artery bypass grafting (CABG) and/or valve replacement in a single institution over a 5-year period.

Carotid arteries were initially assessed with carotid duplex studies, most performed within a month of surgery. To verify the degree of stenosis in patients with greater than 70% stenosis, the researchers performed a magnetic resonance angiogram, computed tomography angiogram, or conventional angiogram.

Seventy-six patients had a clinically significant ischaemic stroke, most on postoperative day 1. Of these cases, 75% were cardioembolic, 5.3% were large vessel, 15.8% were lacunar, and 3.9% were of undetermined subtype. Eighteen of the 76 cases had more than 50% carotid disease and 239 patients had more than 50% carotid stenosis or occlusion (5 symptomatic, 231 asymptomatic).

All patients with stroke were classified according to the standard Trial of Org 10172 in Acute Stroke Treatment criteria. The involved vascular territory was determined with an independent review of the imaging and definitive clinical information.

One patient had a stroke in the territory of the diseased carotid. Presurgical carotid revascularisation was performed in 74 patients. Of 53 patients having combined carotid endarterectomy/open heart surgery, 13.2% developed postoperative stroke. None of the 16 patients receiving staged surgery had a stroke. At least 53% of the 76 stroke patients were found to have strokes outside a single carotid distribution.

Of the 5 patients who received carotid stenting, 1 had a stroke. Postoperative strokes occurred in 10.3% of the 116 patients who had at least 80% carotid stenosis or carotid occlusion, and in 4.9% of the 123 patients who had 50% to 79% carotid stenosis. Of the 165 patients who did not have any carotid revascularisation procedures, 6.1% had a stroke; 16 patients had at least 80% stenosis (without occlusion) but none developed stroke postoperatively.

The researchers concluded that most postoperative strokes following cardiac surgery are not related to ipsilateral carotid stenosis. While high-grade carotid stenosis is an indicator of higher incidence of postoperative cerebrovascular complications, carotid revascularisation does not play a significant role in preventing strokes in this group of patients.


[Presentation title: Strokes Following Open Heart Surgery Aren't Directly Related to The Stenotic Carotid Artery. Abstract P205]

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