The impact of asymptomatic carotid artery disease on the intraoperative course of coronary artery bypass surgery.
Asymptomatic carotid artery stenosis (CAS) may result in neurological injury after coronary artery bypass surgery, but routine preoperative carotid screening is not undisputed. We studied whether routinely determined carotid duplex results, beyond detecting high-risk patients, additionally influence intraoperative course. One hundred and eight patients without new signs of impaired cerebral circulation were investigated. Anesthesiology, perfusionist records, and patient files were reviewed for patient characteristics, intraoperative variables and postoperative neurological sequelae. There was a higher incidence of prior cerebrovascular events and peripheral artery disease in CAS patients (p < 0.05). Pulsatile flow was employed more frequently in this group (p < 0.05). Severe hyperventilation, hyperglycemia, hemodilution, hyperthermia, and lactacidosis were avoided in both groups. However, labile hemodynamics of CAS patients required more corrective interventions (p < 0.05). There was also a tendency toward greater mortality. Stroke and transient ischemic attack (TIA) occurred in two patients without CAS. Since CAS was associated with a greater degree of cardiovascular instability requiring frequent measures to control hemodynamics, positive duplex results should heighten vigilance. Although CAS does not appear to be the major source of cerebral ischemia, it involves significant comorbidity.
Dworschak
Martin
M
Division of Cardiothoracic Anesthesia and Intensive Care, University Hospital Vienna, Vienna, Austria. dworschak.martin@mayo.edu
Czerny
Martin
M
Grimm
Michael
M
Grubhofer
Georg
G
Plöchl
Walter
W
D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D020521:Stroke / Q000209:etiology; D014463:Ultrasonography