title: Strokes after cardiac surgery and relationship to carotid stenosis.
abstract: OBJECTIVE
  To critically examine the role of significant carotid stenosis in the pathogenesis of postoperative stroke following cardiac operations.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single tertiary care hospital.
  
  
  METHODS
  A total of 4335 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both.
  
  
  METHODS
  Incidence, subtype, and arterial distribution of stroke.
  
  
  RESULTS
  Clinically definite stroke was detected in 1.8% of patients undergoing cardiac operations during the same admission. Only 5.3% of these strokes were of the large-vessel type, and most strokes (76.3%) occurred without significant carotid stenosis. In 60.0% of cases, strokes identified via computed tomographic head scans were not confined to a single carotid artery territory. According to clinical data, in 94.7% of patients, stroke occurred without direct correlation to significant carotid stenosis. Undergoing combined carotid and cardiac operations increases the risk of postoperative stroke compared with patients with a similar degree of carotid stenosis but who underwent cardiac surgery alone (15.1% vs 0%; P = .004).
  
  
  CONCLUSIONS
  There is no direct causal relationship between significant carotid stenosis and postoperative stroke in patients undergoing cardiac operations. Combining carotid and cardiac procedures is neither necessary nor effective in reducing postoperative stroke in patients with asymptomatic carotid stenosis.
authors.affiliation: Department of Medicine, Lehigh Valley Hospital and Health Network, 1250 S Cedar Crest Blvd, Ste 405, Allentown, PA 18103, USA.
authors.forename: Yuebing
authors.initials: Y
authors.lastname: Li
authors.forename: Debra
authors.initials: D
authors.lastname: Walicki
authors.forename: Claranne
authors.initials: C
authors.lastname: Mathiesen
authors.forename: Donna
authors.initials: D
authors.lastname: Jenny
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Isayev
authors.forename: James F
authors.initials: JF
authors.lastname: Reed
authors.forename: John E
authors.initials: JE
authors.lastname: Castaldo
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000503:physiopathology; D015984:Causality; D002985:Clinical Protocols / Q000592:standards; D015331:Cohort Studies; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed