ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Comparison of the incidences of carotid artery lesion and vertebrobasilary insufficiency with incidence of postoperative stroke in patients who undergo coronary artery bypass graft surgery
Aykut Ülger1, Sinan Şahin1, F. Esra Bahadır2, Nail Uzunlulu1, Abdullah Kemal Tuygun3, Yücesin Arslan3, Fuat Bilgen3
1Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul
2Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, İstanbul
3Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
DOI : 10.5606/tgkdc.dergisi.2011.001
Background: In this study we compared the incidences of carotid artery lesions and vertebrobasilar insufficiency (VBI) with postoperative stroke incidence and evaluated the contribution of carotid endarterectomy (CEA) to the treatment plan in preventing stroke in patients who undergo coronary artery bypass grafting (CABG) surgery.

Methods: Three-hundred patients (232 males, 68 females; mean age 62.7±9.3 years; range 31 to 79 years) in whom CABG surgery was planned were enrolled in the study. In all patients, preoperative carotid and vertebral color Doppler ultrasonography (CDUS) was performed. The patients were preoperatively questioned for the risk factors for carotid artery stenosis and stroke, namely age, gender, smoking, diabetes mellitus, hypertension, hypercholesterolemia, previous stroke, the number of diseased coronary arteries and previous myocardial infarction. The carotid artery stenoses were classified as normal, mild (<50%), moderate (50-69%), severe (70-99%) and occlusion. A total vertebral artery flow volume below 200 ml/min was accepted as VBI. Cranial computed tomography without contrast was used for the diagnosis of postoperative stroke. The localizations and stages of the lesions were determined.

Results: Carotid lesion was detected in 83% of the patients. Significant stenosis (≥50%) and total occlusion were found in 15.3% and 2.3% of the patients, respectively. Vertebrobasilary insufficiency was detected in 29% of the patients. Seven (2.3%) patients had postoperative stroke, five of them were in the anterior and two of them were in the the posterior system. Stroke was found to be significantly related to ≥50% carotid stenosis, and stroke history, whereas no significant relation was found between VBI and stroke. In postoperative period one of the four deaths (1.3%) was caused by stroke. The mortality rate in patients who had postoperative stroke was 14.2%. While no stroke was observed in seven of 19 patients with high-grade stenosis and oclusion who underwent CEA, stroke was seen in two of the 12 patients who did not undergo CEA had stroke.

Conclusion: It is highly important to evaluate carotid stenosis with CDUS, which is the most important risk factor for stroke as it increases the mortality rate 10 folds after CABG operation. Treating the carotid lesions with CEA reduces the stroke incidence and mortality rate.

Keywords : Carotid artery lesion, coronary artery bypass grafting surgery; stroke; vertebrobasillary insufficiency
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