Evaluation and Treatment of Carotid Stenosis in Open-Heart Surgery Patients
| Autor: | Andrew A. Gage, Lakshmikumar Pillai, G. R. Curl, Samuel C. Balderman, Irineo Z. Gutierrez, John J. Ricotta |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
medicine.medical_specialty
Time Factors medicine.medical_treatment Coronary Disease Carotid endarterectomy Preoperative care Asymptomatic Brain Ischemia Preoperative Care medicine Humans Carotid Stenosis cardiovascular diseases Coronary Artery Bypass Photoplethysmography Stroke Retrospective Studies Endarterectomy Endarterectomy Carotid Intraoperative Care medicine.diagnostic_test Vascular disease business.industry medicine.disease Surgery Cerebrovascular Disorders Stenosis Carotid Arteries Angiography medicine.symptom business |
| Zdroj: | Journal of Surgical Research. 57:312-315 |
| ISSN: | 0022-4804 |
| DOI: | 10.1006/jsre.1994.1150 |
| Popis: | Indications for identification and treatment of extracranial carotid artery disease in candidates for open-heart surgery (OHS) remain unsettled. We evaluated the efficacy of OPG-GEE screening and our nonrandomized use of carotid endarterectomy in 2312 OHS patients from 1975 to 1989. Data was analyzed using the chi 2 squared and Fisher's exact tests. OPG was performed in 1602/2312 (69%) of the patients. OPG was positive in 122/1602 patients (7.6%) and negative in 1480/1602 (92.4%) patients. Of the patients with positive OPG, 31 patients had insignificant carotid bifurcation disease, 32 patients had total internal carotid artery occlusion, and 59 patients had operable carotid bifurcation lesions. Selective use of angiography identified an additional 8 patients with operable carotid bifurcation lesions (total 67, 33 symptomatic and 34 asymptomatic). Overall stroke rate for 2312 patients was 40/2312 (1.7%) [30 day mortality rate 60/2312 (3.2%)]. Stroke incidence was significantly increased (P < 0.01) in patients with a positive OPG, 8/122 (6.60%) vs those with negative OPG (23/1480, 1.6%). However, it was most marked in patients with operable bifurcation lesions (6/67, 9.0%). Stroke was not increased in patients with carotid occlusion or positive OPG without significant carotid bifurcation disease (2/63, 3.20%). Carotid endarterectomy in patients with operable bifurcation lesions was associated with a decreased (P < 0.05) stroke rate after OHS (1/44, 2.30% vs 5/23, 21.7%). Our data suggests identification of significant carotid disease and carotid endarterectomy will decrease stroke after OHS. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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