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There were 145 vascular and 213 coronary bypass operations.Ten of the 49 cases with prior symptoms of cerebral ischemia(38 carotid,11 vertebrobasilar)had symptomatic stenosis of 50%or greater or occlusion,and 3 of these(30%)had ipsilateral perioperative cerebral infarction(95% confidence interval,6.67%to 65.25%).Two of these occurred ipsilateral to symptomatic carotid occlusions,and 1 occurred ipsilateral to an 80% symptomatic stenosis.One symptomatic patient with bilateral 30%stenosis had a perioperative infarct in the asymptomatic hemisphere.Among the 309 asymptomatic patients,1 perioperative infarct occurred ipsilateral to carotid stenosis of 30%.In all there were 5(1.4%)perioperative(within 72 hours)and 2 late(after 18 days)strokes.All strokes were hemisphere infarcts confirmed by computed tomography.There were 53 cases with 50%or greater asymptomatic carotid stenosis or occlusion,including 28 with 80%or greater stenosis or occlusion.None had an ipsilateral stenosis or occlusion,including 28 with 80%or greater stenosis or occlusion.None had an ipsilateral perioperative stroke(95%confidence interval,0%to 6.72%).We conclude that the risk of perioperative stroke related to symptomatic carotid stenosis may be high,but for asymptomatic carotid stenosis the risk is low and does not justify preoperative prophylactic carotid endarterectomy. |
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cardiac surgery,neurologic complications with
carotid artery disease
carotid artery disease,asymptomatic
carotid artery stenosis
carotid artery stenosis,symptomatic
cerebrovascular accident
cerebrovascular accident,postoperative
coronary artery bypass
endarterectomy,carotid
neurologic complications of,surgery
postoperative neurologic complications
risk factors
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