Management of patients with carotid bruit undergoing cardiopulmonary bypass.
During a 31 month period, 1,433 consecutive patients undergoing cardiac procedures were screened for carotid bruit. A total of 94 patients with carotid bruit were identified who had ultrasonic carotid duplex scans. Nine patients had a history of transient ischemic attack, carotid bruit, and reduction in internal carotid artery diameter by greater than or equal to 50% according to ultrasonic carotid duplex scanning. All nine patients underwent carotid angiography followed by thromboendarterectomy prior to or simultaneous with cardiopulmonary bypass. There was one neurological complication leading to death in this subset. Sixteen patients with asymptomatic carotid bruit had ultrasonic carotid duplex scanning revealing an internal carotid artery lesion of greater than or equal to 50% but did not undergo arteriography or thromboendarterectomy prior to the cardiac procedure. Perfusion pressure was maintained at greater than or equal to 70 mm Hg during bypass. There were no focal neurological events in this subset. Sixty-six patients with internal carotid artery stenosis of less than 50% diameter reduction and asymptomatic bruits had no further work-up or modification in perfusion technique, and there were no focal neurological events in this group. Thus there were no focal neurological events in any of the 82 patients with asymptomatic carotid bruit. An additional group of three patients with a previous stroke and internal carotid artery occlusion by ultrasonic carotid duplex scanning had transient exacerbation of neurological symptoms after cardiopulmonary bypass. The remaining 1,339 patients without carotid bruit had nine (0.7%) focal neurological events postoperatively. We believe that asymptomatic patients with or without hemodynamically significant stenosis can safely undergo cardiopulmonary bypass procedures without carotid thromboendarterectomy. Patients with asymptomatic bruits can be safely screened with ultrasonic carotid duplex scanning and do not require arteriography prior to cardiopulmonary bypass.
D001314:Auscultation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000150:complications / Q000209:etiology; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D004691:Endarterectomy; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis; D014463:Ultrasonography