Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened?

Özyalçın, Sertan; Diken, Adem İlkay; Yalçınkaya, Adnan; Türkmen, Ufuk

doi:10.33963/kp.15649

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…The reason for this may be the cost. However, since the coexistence of the two pathologies will increase mortality and morbidity, hence, many centers perform carotid artery screening before CABG (23). CAS was detected in a total of 17 (29%) patients with this screening, which was also performed in our clinic.…”

Section: Discussionmentioning

confidence: 90%

Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

KETENCİLER

Gemalmaz

Gültekin

2022

Anatolian Current Medical Journal

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Aim: Central nervous system may be affected after coronary artery by-pass graft (CABG) and carotid artery stenosis is an important risk factor. Near infrared spectroscopy (NIRS) is used to measure the regional cerebral oxygen concentration (rScO2). The aim of this study is to determine the relationship of rScO2 in patients with carotid artery lesion and to determine the relation of stroke with rScO2 changes. Material and Method: The patients who had cardiac bypass surgery were involved in the study. Demographic characteristics and presence of carotid artery stenosis, were collected from the files. Bilateral rSO2 measurements performed by 2 sensors. RScO2 values are detected in 5 minutes of cross-clamp (XCL5), XCL30, XCL60, XCL90, XCL120 and after the by-pass. Results: 57 patients were involved in the study (40 male and mean age 62.54±13.08). 17 (29%) patients had carotid stenosis. rScO2 levels are statistically significantly decreased in the patients with stenosis after post-clamp 30 minutes. Three patients had stroke after surgery (5.2%). Two of the patients had carotid stenosis while one patient did not have. Conclusion: RScO2 decreased in carotid artery stenosis irrespective of the degree of the stenosis after 30 minutes of cross-clamp. Cerebral perfusion follow-up is important during the CPB and NIRS is a method that can be used for this purpose.

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Section: Discussionmentioning

confidence: 90%

Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

KETENCİLER

Gemalmaz

Gültekin

2022

Anatolian Current Medical Journal

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Estenosis carotídea asociada a cardiopatía isquémica en pacientes tratados con revascularización miocárdica

Sterling-Aracena¹,

López-Taylor²,

Pinal-García³

et al. 2023

Cirugía Cardiovascular

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Temporal Trends and Determinants of Stroke Risk in Patients With Medically Treated Asymptomatic Carotid Stenosis

Poorthuis

Solomon

Herings

et al. 2023

Stroke

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BACKGROUND: Effectiveness of carotid procedures (surgery and stenting) in patients with asymptomatic carotid artery stenosis (ACAS) depends on the absolute risk reduction that patients might receive from these procedures. We aimed to quantify the risk of ipsilateral ischemic stroke and examined temporal trends and determinants of these risks in patients with ACAS treated conservatively. METHODS: We conducted a systematic review from inception to March 9, 2023, of peer-reviewed trials and cohort studies describing ipsilateral ischemic stroke risk in medically treated patients with ACAS of ≥50%. Risk of bias was assessed with an adapted version of the Quality in Prognosis Studies tool. We calculated the annual incidence rates of ipsilateral ischemic stroke. We explored temporal trends and associations of sex and degree of stenosis with ipsilateral ischemic stroke using Poisson metaregression analysis and incidence rate ratios, respectively. RESULTS: After screening 5915 reports, 73 studies describing ipsilateral ischemic stroke rates of 28 625 patients with midyear of recruitment ranging from 1976 to 2014 were included. The incidence of ipsilateral ischemic stroke was 0.98 (95% CI, 0.93–1.04) per 100 patient-years (median duration of follow-up, 3.3 years). The incidence decreased 24% with every 5 years more recent midyear of recruitment (rate ratio, 0.76 [95% CI, 0.73–0.78]). Incidence rates of ipsilateral ischemic stroke were lower in female patients (rate ratio, 0.74 [95% CI, 0.63–0.87]) and in patients with moderate versus severe stenosis when assessed in cohort studies, with incidence rate ratios of 0.41 ([95% CI, 0.35–0.49] cutoff, 70%) and 0.42 ([95% CI, 0.30–0.59] cutoff, 80%). CONCLUSIONS: Reported risks of ipsilateral ischemic stroke in patients with ACAS have declined 24% every 5 years from mid-1970s onward, further challenging the routine use of carotid procedures. Risks were lower in female patients and more than twice as high with severe compared with moderate ACAS. Inclusion of these findings in individualized risk assessment can help to determine the benefit of carotid procedures in selected individual patients with ACAS. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42021222940.

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Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened?

Cited by 3 publications

References 18 publications

Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

Estenosis carotídea asociada a cardiopatía isquémica en pacientes tratados con revascularización miocárdica

Temporal Trends and Determinants of Stroke Risk in Patients With Medically Treated Asymptomatic Carotid Stenosis

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