Stroke after coronary artery bypass grafting in patients with cerebrovascular disease.
BACKGROUND
Stroke has been associated with a significantly increased mortality from coronary artery bypass grafting (CABG). To determine the predictors of stroke in patients undergoing CABG, we collected data on 472 consecutive patients.


METHODS
From March 1991 to March 1999, all patients undergoing CABG at our institution underwent routine duplex scanning of the extracranial carotid and vertebral arteries. Seven patients with symptomatic carotid stenosis were treated by carotid endarterectomy (CEA) before CABG.


RESULTS
There was a 10-fold increase in mortality (12.5%) associated with postoperative stroke. Many variables were analyzed by a multivariate technique and the severity of extracranial carotid artery stenosis was determined to be the only independent predictor of postoperative stroke (p < 0.01). None of the patients with carotid artery occlusion and none of the patients who underwent CEA before CABG experienced a stroke.


CONCLUSIONS
To reduce the stroke rate, the indications for prophylactic CEA may be extended for asymptomatic patients with carotid artery stenosis greater than 75%.
Hirotani
T
T
Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan. hero.takashi@nifty.ne.jp
Kameda
T
T
Kumamoto
T
T
Shirota
S
S
Yamano
M
M
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology*; D014463:Ultrasonography; D014711:Vertebral Artery / Q000000981:diagnostic imaging