Perioperative Medicine
نویسندگان
چکیده
Cerebrovascular complications, such as stroke, are a common source of morbidity and mortality after cardiac surgery. Although the cause of postoperative stroke is multifactorial, significant carotid stenosis is a positive predictor. Carotid and cardiac surgical procedures are often combined to reduce the risk of stroke; however, this may actually increase adverse events, including stroke. This retrospective study at a single tertiary care hospital was conducted to critically examine the role of significant carotid stenosis in the pathogenesis of postoperative stroke after cardiac operations. A total of 4,335 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both were enrolled. Clinically definitive 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% of cases, strokes identified using computed topographic head scans were not confined to a single carotid artery territory. Stroke occurred without direct correlation to significant carotid stenosis in 94.7% of patients. Patients who underwent combined carotid and cardiac operations had an increased risk for postoperative stroke (15.1%). None of the patients with a similar degree of carotid stenosis, but who underwent cardiac surgery alone, had a postoperative stroke (P 0.004).
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