Association of carotid artery stenosis and ischemic stroke in patients undergoing coronary artery bypass grafting

Abstract

Background. The incidence of stroke after Coronary artery bypass grafting (CABG) and the effect of carotid artery stenosis for risk assessment of stroke was strongly needed. This study compared the relation of ischemic stroke in the patients posted for CABG with varying degree of carotid artery stenosis (CAS) as measured by carotid artery Doppler. Patients and methods. This prospective cross-sectional study enrolled 422 patients with coronary artery disease (CAD) who underwent CABG. Out of them 170 patient with concomitant CAD were selected and divided into three groups such as mild, moderate and severe CAS. The occurrence of stroke was measured. Results. Unilateral CAS was common than bilateral CAS (71.2% vs 28.8%). Mild CAS was more than moderate and severe CAS (72.4% vs 21.2% vs 6.5%). Stroke observed in 1.2%, in which one patient had moderate CAS and other had severe CAS on the side of clinical stroke post CABG. Right carotid disease was frequent among 3 groups (51.8% vs 47.6%; 11.8% vs 10.6%; 4.1% vs 3.5%). Patient with old stroke showed significant correlation with the severity of CAD (p=0.02). Post-surgery stroke had significant correlation with previous history of stroke (p=0.001), severity of CAD (p=0.01) and bilateral CAS (p=0.02). Post-operative low volume state requiring prolonged ionotropic support showed significant correlation to stroke (p=0.02). Conclusion. Screening of patients for CAS in patients age >65 years with previous stroke, and comorbidities aids the surgeon to take required measures to prevent stroke as a complication intraoperative or postoperative and decrease morbidity to the patient.