Relationship Between the Degree of Carotid Stenosis and the Risk of Stroke in Patients Undergoing Cardiac Surgery

The impact of carotid stenosis (CS) in patients undergoing cardiac surgery remains controversial. The aim of this study was to evaluate the association between carotid stenosis and stroke and/or transient ischemic attack (TIA) in patients undergoing cardiac surgery on cardiopulmonary bypass. This wa...

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Bibliographic Details
Published in:	Canadian journal of cardiology 2022-03, Vol.38 (3), p.347-354
Main Authors:	Ruka, Emmeline, Lesur, Olivier, Gingras, Michel, Buruian, Mara, Voisine, Emile, Marzouk, Mohamed, Dagenais, François, Voisine, Pierre
Format:	Article
Language:	eng
Subjects:	Aged Canada - epidemiology Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - statistics & numerical data Cardiopulmonary Bypass - methods Carotid Stenosis - diagnosis Carotid Stenosis - epidemiology Female Humans Ischemic Attack, Transient - diagnosis Ischemic Attack, Transient - epidemiology Ischemic Attack, Transient - etiology Male Outcome and Process Assessment, Health Care Postoperative Complications - diagnosis Postoperative Complications - epidemiology Prognosis Risk Assessment - methods Risk Assessment - statistics & numerical data Risk Factors Severity of Illness Index Stroke - diagnosis Stroke - epidemiology Stroke - etiology Survival Analysis
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Summary:	The impact of carotid stenosis (CS) in patients undergoing cardiac surgery remains controversial. The aim of this study was to evaluate the association between carotid stenosis and stroke and/or transient ischemic attack (TIA) in patients undergoing cardiac surgery on cardiopulmonary bypass. This was a retrospective cohort study including patients undergoing cardiac surgery on cardiopulmonary bypass from January 2006 to March 2018 at the Québec Heart and Lung Institute. Data of patients’ preoperative demographic characteristics, operative and postoperative variables were taken from a computerised database and patients’ charts. Univariate and multivariate analyses were performed. A total of 20,241 patients were included in the study. Among those who had received preoperative carotid ultrasound, 516 (2.6% of the total population) had unilateral or bilateral CS ≥ 50%. Categorised levels of CS severity were identified as independent risk factors for postoperative stroke and/or TIA. There was an almost 3-fold increased risk of postoperative neurologic events in 80%-99% CS vs less severe 50%-79% CS (odds ratio 2.91, 95% confidence interval 1.30-6.54), suggesting that the degree of severity of CS is potentially a strong independent predictor of postoperative neurologic events. CS is an independent risk factor of postoperative stroke and/or TIA. This study suggests for the first time that the risk of stroke increases with the degree of severity of CS, with the greatest risk being for CS of 80%-99%. The strength of this relationship and potential causality effect should be further explored in a prospective study focusing on this population most at risk. Les répercussions d’une sténose carotidienne (SC) chez les patients qui subissent une chirurgie cardiaque demeurent controversées. Cette étude visait à évaluer le lien entre une sténose ca-rotidienne et la survenue d’un accident vasculaire cérébral (AVC) ou d’un accident ischémique transitoire (AIT) chez des patients qui su-bissent une chirurgie cardiaque avec circulation extra-corporelle. Il s’agissait d’une étude rétrospective de cohorte menée chez des patients ayant subi une chirurgie cardiaque avec circulation extra-corporelle entre janvier 2006 et mars 2018 à l’Ins-titut universitaire de cardiologie et de pneumologie de Québec. Les données sur les caractéristiques démographiques préopératoires des patients et sur les variables opératoires et postopératoires ont été tirées d’une base de données informatisée et d
ISSN:	0828-282X 1916-7075