Prevalence of carotid artery stenosis and perioperative stroke in neurologically asymptomatic patients undergoing off pump coronary artery bypass grafting in a tertiary care hospital: An observational study

Abstract

The study aimed to determine the prevalence of carotid artery stenosis, it’s severity and relation with peri-operative stroke in neurologically asymptomatic patients undergoing CABG for coronary artery disease (CAD) in a tertiary care hospital. It also evaluates the relationship of hemodynamic alterations with the prevalence of stroke. It is a cross sectional study with prospective observations. 97 neurologically asymptomatic patients with CAD in NYHA classification I, II and III scheduled for Off Pump CABG in our cardiac surgery operation theatre. Colour doppler ultrasound was performed in all patients prior to induction to determine the presence of carotid artery stenosis. Based on parameters measured in ultrasound, CAS was classified as per the Society of Radiologists criteria. Prevalence of carotid artery stenosis was assessed. The prevalence of carotid artery stenosis in our study population was 40.2%. The risk factors associated with CAS in our study were BMI >25kg/m2, smoking, left main coronary artery involvement, left ventricular systolic dysfunction (EF<50%). However, risk of CAS was also increased in hypertensive patients and those of age more than 55 years. This study suggested relatively wide prevalence (40.2%) of carotid artery disease in neurologically asymptomatic patients undergoing CABG for coronary artery disease in the elective setting. It demonstrated the importance of subjecting these patients to evaluation by doppler ultrasound of the carotid vessels in the operating room immediately before induction of anaesthesia and the subsequent planning of anaesthetic management as well as surgical approach.