P3.04-015 Usefulness of Carotid Ultrasonography for Postoperative Cerebrovascular Complication Prevention in Patients with Lung Cancer: Topic: Miscellaneous I

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In Japan, the incidence of postoperative cerebral infarction in lung cancer is approximately 0.9%. Reportedly, carotid artery arteriosclerosis reflects arteriosclerosis in the whole body. We aimed to assess whether carotid ultrasonography contributes to the prevention of cerebral infarction and cardiovascular events in postoperative lung cancer patients, and identify preoperative factors for its indication. We analyzed 1418 consecutive patients with NSCLC who underwent surgical resection at Kyushu Medical Center between 1994 and 2014. Between 1994 and 2000 (first event), 334 patients with NSCLC did not undergo carotid ultrasonography. From 2001 and on (second event), 1084 consecutive patients underwent carotid ultrasonography. In cases of moderate or severe carotid artery stenosis, we used heparin infusion as cerebral infarction prevention. At the first event, postoperative cerebral infarction occurred in four patients (1.2%) who did not present preoperative cerebrovascular episodes. At the second event, four patients (0.36%) of 1084 presented postoperative cerebral infarction. We analyzed 130 patients (12.0%) of 1084 patients with over 30% carotid stenosis. Only 13 (10%) of 130 patients had preoperative cerebral infarction and 117 (90%) of 130 patients did not present preoperative cerebrovascular episodes. All 130 patients were aged >51 years. In total, 58 (44.6%) patients with mild stenosis (linear internal carotid artery [ICA] 30%–49%), 56 (43.0%) patients with moderate stenosis (linear ICA 50%–69%), and 16 (12.4%) patients with severe stenosis (linear ICA <70%) were identified. The stenosis rate increased with age. Severe stenosis was identified in 16 patients, of which 15 had no preoperative cerebrovascular episodes. At the second event, there were 74 (6.8%) cases of preoperative cerebral diseases; 303 (28.0%), hypertension; 72 (6.6%), coronary artery disease; 11 (1.0%), arrhythmia; 19 (1.8%), peripheral vascular diseases; 14 (1.3%), abdominal aortic aneurysm; and 121 (11.2%), diabetes mellitus. There was a significant correlation between carotid stenosis and hypertension and smoking and diabetes mellitus and smoking (p<0.001). The incidence of postoperative cerebro-cardiovascular comorbidity was 25 (7.4%) and 26 (2.3%) at the first and second events, respectively. There was a significant difference between the two occurrences of postoperative cerebral infarction (p=0.008) and cardiovascular complications (p=0.001). Carotid ultrasonography is recommended for patients aged above 50 years, with hypertension and smoking, and diabetes mellitus and smoking. Even without past cerebral infarction, the likelihood of carotid artery stenosis is high with increasing age. Carotid ultrasonography is simple, noninvasive, and useful as a preoperative assessment for preventing postoperative cerebro-cardiovascular complications in lung cancer patients.