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Concomitant Coronary Artery and Carotid Disease

Sheelagh Pousatis, MD, Bradley Taylor, MD, James Gammie, MD
Concomitant Coronary Artery and Carotid Disease is a topic covered in the Adult and Pediatric Cardiac.

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Introduction

There are more than 300,000 coronary artery bypass grafting (CABG) surgeries performed in the United States annually. In today’s medical practice, CABG is held to increasing standards of excellence and safety. Common outcome measures, which are tracked after CABG, include postoperative myocardial infarction (MI), stroke, and death. Perioperative stroke is a dreaded complication of CABG and can lead to permanent disability, other morbidities, or even death. Perioperative stroke rates range from 2.1% to 5.2% in the literature.[1],[2] Definitions vary; however, perioperative stroke can include intraoperative stroke up until 14 to 30 days after surgery. The risk factors that predispose patients to coronary artery disease similarly predispose patients to atherosclerosis in other arteries, so cardiac surgical patients are likely to have some degree of carotid stenosis.

Approximately 22% of patients with coronary artery disease have greater than 50% concomitant carotid stenosis.[3],[4] Carotid stenosis is a risk factor for perioperative stroke, but the role of carotid stenosis and the percentage of perioperative strokes that can be attributed to carotid stenosis are controversial as carotid stenosis has not been shown to be an independent risk factor when controlling for aortic arch atherosclerosis. Patients with coronary artery disease are also likely to be asymptomatic from their carotid stenosis. Thus, sufficient data do not exist that clearly address the need to surgically correct carotid stenosis in patients with coronary artery disease.

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Introduction

There are more than 300,000 coronary artery bypass grafting (CABG) surgeries performed in the United States annually. In today’s medical practice, CABG is held to increasing standards of excellence and safety. Common outcome measures, which are tracked after CABG, include postoperative myocardial infarction (MI), stroke, and death. Perioperative stroke is a dreaded complication of CABG and can lead to permanent disability, other morbidities, or even death. Perioperative stroke rates range from 2.1% to 5.2% in the literature.[1],[2] Definitions vary; however, perioperative stroke can include intraoperative stroke up until 14 to 30 days after surgery. The risk factors that predispose patients to coronary artery disease similarly predispose patients to atherosclerosis in other arteries, so cardiac surgical patients are likely to have some degree of carotid stenosis.

Approximately 22% of patients with coronary artery disease have greater than 50% concomitant carotid stenosis.[3],[4] Carotid stenosis is a risk factor for perioperative stroke, but the role of carotid stenosis and the percentage of perioperative strokes that can be attributed to carotid stenosis are controversial as carotid stenosis has not been shown to be an independent risk factor when controlling for aortic arch atherosclerosis. Patients with coronary artery disease are also likely to be asymptomatic from their carotid stenosis. Thus, sufficient data do not exist that clearly address the need to surgically correct carotid stenosis in patients with coronary artery disease.

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Last updated: October 2, 2020