Reprinted article "Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature".

Journal article

OBJECTIVES: To determine the role of carotid artery disease in the pathophysiology of stroke after coronary artery bypass (CABG). DESIGN: Systematic review of the literature. RESULTS: The risk of stroke after CABG was 2% and remained unchanged between 1970-2000. Two-thirds occurred after day 1 and 23% died. 91% of screened CABG patients had no significant carotid disease and had a <2% risk of peri-operative stroke. Stroke risk increased to 3% in predominantly asymptomatic patients with a unilateral 50-99% stenosis, 5% in those with bilateral 50-99% stenoses and 7-11% in patients with carotid occlusion. Significant predictive factors for post-CABG stroke included; (i) carotid bruit (OR 3.6, 95% CI 2.8-4.6), (ii) prior stroke/TIA (OR 3.6, 95% CI 2.7-4.9) and (iii) severe carotid stenosis/occlusion (OR 4.3, 95% CI 3.2-5.7). However, the systematic review indicated that 50% of stroke sufferers did not have significant carotid disease and 60% of territorial infarctions on CT scan/autopsy could not be attributed to carotid disease alone. CONCLUSIONS: Carotid disease is an important aetiological factor in the pathophysiology of post-CABG stroke. However, even assuming that prophylactic carotid endarterectomy carried no additional risk, it could only ever prevent about 40-50% of procedural strokes.

Authors: Naylor, A; Mehta, Z; Rothwell, P; Bell, P

• Publication status: Published
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
• Volume: 42 Suppl 1
• Pages: S73-S83
• Publication date: 2011-09-01
• DOI: 10.1016/j.ejvs.2011.06.020
• EISSN: 1532-2165
• ISSN: 1078-5884
• Language: English
• Keywords: Carotid artery disease; Coronary bypass; Stroke