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Influence of carotid artery stenosis on stroke in patients undergoing off-pump coronary artery bypass grafting

Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahicho 3-16-1, Fuchu, Tokyo 183-0003, Japan

Received 27 March 2008; received in revised form 13 July 2008; accepted 4 August 2008.

^_* Corresponding author. Tel.: +81 42 314 3111; fax: +81 42 234 0441. (Email: s-manabe{at}fb3.so-net.ne.jp).

Objective: It is well known that the presence of carotid artery stenosis increases the risk of perioperative stroke in patients undergoing cardiac surgery with cardiopulmonary bypass. Although off-pump coronary artery bypass grafting (CABG) can avoid the adverse effects of cardiopulmonary bypass, the influence of carotid artery stenosis on the incidence of stroke in patients undergoing off-pump CABG has not been well clarified. Methods: We conducted a retrospective study of 461 patients who underwent elective off-pump CABG after screening for carotid artery stenosis at our institute between September 2004 and May 2007. The incidence and etiologies of stroke were identified. Preoperative screening revealed significant carotid artery stenosis in 49 patients. Clinical results were compared between patients with and without carotid artery stenosis. Results: Postoperative stroke occurred in two (0.43%) of the 462 study patients, and in-hospital mortality occurred in three (0.65%). Stroke was due to decreased perfusion resulting from hypovolemic shock in one and thrombosis in the other. There was neither stroke nor in-hospital mortality in patients with carotid artery stenosis, although there were two strokes (0.49%) and three in-hospital mortalities (0.73%) in patients without carotid artery stenosis. Conclusions: The influence of carotid artery stenosis on the incidence of perioperative stroke may be little in off-pump CABG, especially in patients with moderate carotid artery stenosis.

Key Words: CABG • Off-pump • Carotid arteries • Cerebral complications