Influence of Carotid Injury in Post-Myocardial Revascularization Surgery and Its Late Evolution

Comparison Between Treatment Strategies of Carotid Stenosis in Patients Undergoing Coronary Artery Bypass Grafting

“…Among patients with coronary artery disease, simultaneous carotid obstruction may occur in up to 22% of the cases [ 1 , 2 ] . Perioperative stroke is a severe coronary artery bypass grafting (CABG) complication with an incidence ranging from 0.8 to 5.2% [ 3 , 4 ] , being strongly related to the degree of the carotid stenosis (CS) [ 5 - 7 ] and tripling cardiac surgery mortality [ 8 ] . Several factors contribute to its occurrence such as age, diabetes mellitus, smoking, aortic calcification, atrial fibrillation (AF), cardiopulmonary bypass (on-pump time), and pre-existence of carotid artery disease [ 9 - 13 ] .…”

Prevalence of Carotid Stenosis and Incidence of Ischemic Stroke in Patients Undergoing Non-Coronary Cardiac Surgery

“…Revelo et al, in a Brazilian sample of 1,169 patients submitted to coronary surgery, showed that 19.9% presented CS ≥50%, 8.6% had CS ≥70% and 2% had unilateral occlusion. Among patients with severe CS who underwent intervention for preoperative treatment, the incidence of TIA, stroke and death was 12.5% versus 3.4% for patients not undergoing CS treatment ( P =0.24) [12] . For Naylor and Bown, carotid lesions would be considered markers of stroke rather than associated with its etiology, since they observed that groups of patients with unilateral stenosis above 50% or above 70% had no change in the incidence of stroke [2] .…”

“…Many studies have correlated carotid stenosis (CS) with coronary artery disease, coronary artery bypass grafting, and stroke risk [1-12] . Nevertheless, the literature is poor regarding the correlation between CS and non-coronary cardiac surgery, which may result from lack of studies in the area rather than actual negative evidence of association.…”

“…That guideline recommends performing prophylactic treatment with endarterectomy or stenting in the carotid artery in selected cases [11] . However, Revelo et al [12] when reporting a Brazilian case series, demonstrated that patients with severe CS who underwent intervention for treatment during the perioperative period had worse prognosis [12] . On the other hand, for Naylor and Bown [2] carotid lesions would be more significant markers of stroke than associated with its etiology, since these authors observed that groups of patients with unilateral stenosis above 50 or 70% did not present alterations in the incidence of stroke [2] .…”