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 50e59%, 6.0% of 60e69%, 3.1% of 70e79%, 1.4% of 80e89%, 0.5% of 90e99%, 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 ¼ 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%; 50e59%, 1.0%; 60e69%, 0.6%; 70e79%, 1.2%; 80e89%, 5.1%; 90e99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90e99% (OR 12.03, 95% CI1.34e108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820e42.40) 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.

Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting / Santarpino, G; Nicolini, F; De Feo, M; Dalén, M; Fischlein, T; Perrotti, A; Reichart, D; Gatti, G; Onorati, F; Franzese, I; Faggian, G; Bancone, C; Chocron, S; Khodabandeh, S; Rubino, As; Maselli, D; Nardella, S; Gherli, R; Salsano, A; Zanobini, M; Saccocci, M; Bounader, K; Rosato, S; Tauriainen, T; Mariscalco, G; Airaksinen, J; Ruggieri, Vg; Biancari, F. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - 56:5(2018), pp. 741-748. [10.1016/j.ejvs.2018.07.042]

Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.

Nicolini F;
2018

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 50e59%, 6.0% of 60e69%, 3.1% of 70e79%, 1.4% of 80e89%, 0.5% of 90e99%, 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 ¼ 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%; 50e59%, 1.0%; 60e69%, 0.6%; 70e79%, 1.2%; 80e89%, 5.1%; 90e99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90e99% (OR 12.03, 95% CI1.34e108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820e42.40) 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.
Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting / Santarpino, G; Nicolini, F; De Feo, M; Dalén, M; Fischlein, T; Perrotti, A; Reichart, D; Gatti, G; Onorati, F; Franzese, I; Faggian, G; Bancone, C; Chocron, S; Khodabandeh, S; Rubino, As; Maselli, D; Nardella, S; Gherli, R; Salsano, A; Zanobini, M; Saccocci, M; Bounader, K; Rosato, S; Tauriainen, T; Mariscalco, G; Airaksinen, J; Ruggieri, Vg; Biancari, F. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - 56:5(2018), pp. 741-748. [10.1016/j.ejvs.2018.07.042]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11381/2852263
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