Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting
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Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting. / Santarpino, Giuseppe; Nicolini, Francesco; De Feo, Marisa; Dalén, Magnus; Fischlein, Theodor; Perrotti, Andrea; Reichart, Daniel; Gatti, Giuseppe; Onorati, Francesco; Franzese, Ilaria; Faggian, Giuseppe; Bancone, Ciro; Chocron, Sidney; Khodabandeh, Sorosh; Rubino, Antonino S; Maselli, Daniele; Nardella, Saverio; Gherli, Riccardo; Salsano, Antonio; Zanobini, Marco; Saccocci, Matteo; Bounader, Karl; Rosato, Stefano; Tauriainen, Tuomas; Mariscalco, Giovanni; Airaksinen, Juhani; Ruggieri, Vito G; Biancari, Fausto.
in: EUR J VASC ENDOVASC, Jahrgang 56, Nr. 5, 11.2018, S. 741-748.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting
AU - Santarpino, Giuseppe
AU - Nicolini, Francesco
AU - De Feo, Marisa
AU - Dalén, Magnus
AU - Fischlein, Theodor
AU - Perrotti, Andrea
AU - Reichart, Daniel
AU - Gatti, Giuseppe
AU - Onorati, Francesco
AU - Franzese, Ilaria
AU - Faggian, Giuseppe
AU - Bancone, Ciro
AU - Chocron, Sidney
AU - Khodabandeh, Sorosh
AU - Rubino, Antonino S
AU - Maselli, Daniele
AU - Nardella, Saverio
AU - Gherli, Riccardo
AU - Salsano, Antonio
AU - Zanobini, Marco
AU - Saccocci, Matteo
AU - Bounader, Karl
AU - Rosato, Stefano
AU - Tauriainen, Tuomas
AU - Mariscalco, Giovanni
AU - Airaksinen, Juhani
AU - Ruggieri, Vito G
AU - Biancari, Fausto
N1 - Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
PY - 2018/11
Y1 - 2018/11
N2 - OBJECTIVES: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG).METHODS: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included.RESULTS: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50-59%, 6.0% of 60-69%, 3.1% of 70-79%, 1.4% of 80-89%, 0.5% of 90-99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50-59%, 1.0%; 60-69%, 0.6%; 70-79%, 1.2%; 80-89%, 5.1%; 90-99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90-99% (OR 12.03, 95% CI 1.34-108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820-42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta.CONCLUSIONS: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Unique identifier: NCT02319083.
AB - OBJECTIVES: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG).METHODS: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included.RESULTS: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50-59%, 6.0% of 60-69%, 3.1% of 70-79%, 1.4% of 80-89%, 0.5% of 90-99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50-59%, 1.0%; 60-69%, 0.6%; 70-79%, 1.2%; 80-89%, 5.1%; 90-99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90-99% (OR 12.03, 95% CI 1.34-108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820-42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta.CONCLUSIONS: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Unique identifier: NCT02319083.
KW - Adult
KW - Aged
KW - Carotid Stenosis/diagnosis
KW - Coronary Artery Bypass/adverse effects
KW - Coronary Artery Disease/complications
KW - Endarterectomy, Carotid/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Risk Assessment
KW - Risk Factors
KW - Stroke/etiology
KW - Treatment Outcome
U2 - 10.1016/j.ejvs.2018.07.042
DO - 10.1016/j.ejvs.2018.07.042
M3 - SCORING: Journal article
C2 - 30197287
VL - 56
SP - 741
EP - 748
JO - EUR J VASC ENDOVASC
JF - EUR J VASC ENDOVASC
SN - 1078-5884
IS - 5
ER -