This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (1)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Revascularization  • Cerebrovascular Disease  • Cardiovascular System, Other  • Stroke  • Cardiovascular System  • Surgery  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Yuebing Li, MD, PhD; Debra Walicki, MT; Claranne Mathiesen, RN; Donna Jenny, RN; Qiang Li, MD; Yevgeniy Isayev, MD; James F. Reed III, PhD; John E. Castaldo, MD

Arch Neurol. 2009;66(9):1091-1096.

Objective  To critically examine the role of significant carotid stenosis in the pathogenesis of postoperative stroke following cardiac operations.

Design  Retrospective cohort study.

Setting  Single tertiary care hospital.

Participants  A total of 4335 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both.

Main Outcome Measures  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.

Author Affiliations: Division of Neurology, Department of Medicine (Drs Y. Li, Isayev, and Castaldo and Mss Walicki, Mathiesen, and Jenny), and Departments of Radiology (Dr Q. Li) and Health Studies (Dr Reed), Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

This Month in Archives of Neurology
Arch Neurol. 2009;66(9):1056-1057.
FULL TEXT  

Translating What Is Known About Neurological Complications of Coronary Artery Bypass Graft Surgery Into Action
Louis R. Caplan
Arch Neurol. 2009;66(9):1062-1064.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiac Surgery in Patients with Carotid Stenosis
JWatch General 2009;2009:4-4.
FULL TEXT  

Translating What Is Known About Neurological Complications of Coronary Artery Bypass Graft Surgery Into Action
Caplan
Arch Neurol 2009;66:1062-1064.
FULL TEXT