Abstract 15634: Neurologic Impact of Carotid Stenosis in Cardiac Surgery, a Retrospective Study

Abstract

Context: The impact of carotid disease on the risk of stroke is not well established in patients undergoing surgery on cardiopulmonary bypass (CPB). The aim of this study is to evaluate the relationship between post-operative cerebrovascular events and the characteristics of concomitant carotid stenosis (CS) (degree, laterality and associated symptomatology) in patients undergoing cardiac surgery on CPB. Methodology: Single center retrospective cohort study with prospectively collected data including all patients undergoing cardiac surgery on CPB between January 2002 and February 2014. Data collected included patients’ pre-operative demographic characteristics, operative and post-operative variables, and were taken from a computerized database and patients’ charts. Univariate analysis and multivariate analysis with stepwise approach were performed. Results: Results were obtained for 19,918 patients who met the inclusion criteria. Of these, 474 (2.4%) had at least a unilateral CS ≥50%. By univariate analysis, patients with CS ≥50% had a higher risk of post-operative stroke and/or TIA than those with CS <50% (8.3% vs 2.4%, p<0.0001). In the group of patients with CS ≥50%, neither the laterality of the stenosis (p=0.75) nor the presence of CS-related symptoms (p=0.07) were significantly associated with post-operative stroke and/or TIA. By multivariate analysis, the presence of a ≥50% CS was identified as an independent risk factor for post-operative stroke and/or TIA [OR 2.84; CI95% (1.94-4.16)]. The relationship between the degree of CS (50-99%) and the neurological risk showed a trend toward significance: CS 80-99% vs CS 50-79% [OR 1.77; CI95% (0.81-3.85)], p=0.15. The risk of stroke and/or TIA was highest in the 80-99% CS group [OR 3.80; CI95% (2.14-6.73)]. Conclusion: The presence of a ≥ 50% CS is an independent risk factor for post-operative stroke and/or TIA. Regardless of the presence of preoperative CS-related symptoms, the clinically relevant risk of stroke and/or TIA was highest for CS of 80-99%. These results suggest that a decision to perform prophylactic carotid revascularization prior to cardiac surgery should not only be based on the presence of CS-related symptoms, but also on the severity of carotid stenosis.