Incidence & Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery

Hamoud Obied, Asim Miari, Mohammed Alreshidan, Fahad Alghofaili, Mohammad Ibrahim, Abdulaziz Albaradai, Mohammed Koudieh

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Cardiac Surgery Department, Prince Salman Heart Center, Riyadh, KSA.

DOI: 10.4236/ojts.2014.42005                

Abstract

Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age <60. There is a high risk group for severe carotid stenosis (age > 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.

Keywords

Carotid Artery Disease, Coronary Artery Bypass Grafting, Incidence, Risk Factors, Carotid Duplex Scan

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Faggioli, G.L., Curl, G.R. and Ricotta, J.J. (1990) The Role of Carotid Screening before Coronary Artery Bypass. Journal of Vascular Surgery, 12, 724. http://dx.doi.org/10.1067/mva.1990.24458
[2]	Sheiman, R.G. and Janne d’Othée, B. (2007) Screening Carotid Sonography before Elective Coronary Artery Bypass Graft Surgery: Who Needs It. American Journal of Roentgenology, 188, W475-W479. http://dx.doi.org/10.2214/AJR.06.1024
[3]	Berens, E.S., Kouchoukos, N.T., Murphy, S.F. and Wareing, T.H. (1992) Preoperative Carotid Artery Screening in Elderly Patients Undergoing Cardiac Surgery. Journal of Vascular Surgery, 15, 313-323. http://dx.doi.org/10.1016/0741-5214(92)90253-5
[4]	D’Agostino, R.S., Svensson, L.G., Neumann, D.J., Balkhy, H.H., Williamson, W.A. and Shahian, D.M. (1996) Screening Carotid Sonography and Risk Factors for Stroke in Coronary Artery Surgery Patients. The Annals of Thoracic Surgery, 62, 1714-1723. http://dx.doi.org/10.1016/S0003-4975(96)00885-5
[5]	Gerraty, R.P., Gates, P.C. and Doyle, J.C. (1993) Carotid Stenosis and Perioperative Stroke Risk in Symptomatic and Asymptomatic Patients Undergoing Vascular or Coronary Surgery. Stroke, 24, 1115-1118. http://dx.doi.org/10.1161/01.STR.24.8.1115
[6]	Hogue, C.W., Murphy, S.F., Schechtman, K.B. and Davila Roman, V.G. (1999) Risk Factors for Early or Delayed Stroke after Cardiac Surgery. Circulation, 100, 642-647. http://dx.doi.org/10.1161/01.CIR.100.6.642
[7]	Salasidis, G.C., Latter, D.A., Steinmetz, O.K., Blair, J.F. and Graham, A.M. (1995) Carotid Artery Duplex Scanning in Preoperative Assessment for Coronary Artery Revascularization: The Association between Peripheral Vascular Disease, Carotid Artery Stenosis, and Stroke. Journal of Vascular Surgery, 21, 154-162. http://dx.doi.org/10.1016/S0741-5214(95)70254-7
[8]	Durand, D.J., Perler, B.A., Roseborough, G.S., Grega, M.A., Borowicz Jr., L.M., Baumgartner, W.A. and Yuh, D.D. (2004) Mandatory versus Selective Preoperative Carotid Screening: A Retrospective Analysis. The Annals of Thoracic Surgery, 78, 159-166. http://dx.doi.org/10.1016/j.athoracsur.2004.02.024
[9]	Furlan, A.J. and Craciun, A.R. (1985) Risk of Stroke during Coronary Artery Bypass Graft Surgery in Patients with Internal Carotid Artery Disease Documented by Angiography. Stroke, 16, 797-799. http://dx.doi.org/10.1161/01.STR.16.5.797
[10]	Brener, B.J., Brief, D.K., Alpert, J., Goldenkranz, R.J. and Parsonnet, V. (1987) The Risk of Stroke in Patients with Asymptomatic Carotid Stenosis Undergoing Cardiac Surgery: A Follow-Up Study. Journal of Vascular Surgery, 5, 269-279.
[11]	http://dx.doi.org/10.1016/0741-5214(87)90135-2
[12]	Ghosh, J., Murray, D., Khwaja, N., Murphy, M.O. and Walker, M.G. (2005) The Influence of Asymptomatic Significant Carotid Disease on Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Surgery. European Journal of Vascular and Endovascular Surgery, 29, 88-90. http://dx.doi.org/10.1016/j.ejvs.2004.07.011
[13]	Cosgrove, D.M., Hertzer, N.R. and Loop, F.D. (1986) Surgical Management of Synchronous Carotid and Coronary Artery Disease. Journal of Vascular Surgery, 4, 690-694. http://dx.doi.org/10.1016/0741-5214(86)90310-1
[14]	Schwartz, L.B., Bridgman, A.H., Kieffer, R.W., et al. (1995) Asymptomatic Carotid Artery Stenosis and Stroke in Patients Undergoing Cardiopulmonary Bypass. Journal of Vascular Surgery, 21, 146-153. http://dx.doi.org/10.1016/S0741-5214(95)70253-9
[15]	Siminelakis, S., Kotsanti, A., Siafakas, M., Dimakopoulos, G., Sismanidis, S., Koutentakis, M., Paziouros, C. and Papadopoulos, G. (2009) Is There Any Difference in Carotid Stenosis between Male and Female Patients Undergoing Coronary Artery Bypass Grafting? Interactive Cardiovascular Thoracic Surgery, 9, 823-826. http://dx.doi.org/10.1510/icvts.2009.213249