EVALUATION AND TREATMENT OF CAROTID STENOSIS IN OPEN-HEART-SURGERY PATIENTS

Indications for identification and treatment of extracranial carotid a rtery disease in candidates for open-heart surgery (OHS) remain unsett led. We evaluated the efficacy of OPG-GEE screening and our nonrandomi zed use of carotid endarterectomy in 2312 OHS patients from 1975 to 19 89. Data was analyzed using the chi(2) squared and Fisher's exact test s. OPG was performed in 1602/2312 (69%) of the patients. OPG was posit ive in 122/1602 patients (7.6%) and negative in 1480/1602 (92.4%) pati ents. Of the patients with positive OPG, 31 patients had insignificant carotid bifurcation disease, 32 patients had total internal carotid a rtery occlusion, and 59 patients had operable carotid bifurcation lesi ons. Selective use of angiography identified an additional 8 patients with operable carotid bifurcation lesions (total 67, 33 symptomatic an d 34 asymptomatic). Overall stroke rate for 2312 patients was 40/2312 (1.7%) [30 day mortality rate 60/ 2312 (3.2%)]. Stroke incidence was s ignificantly increased (P < 0.01) in patients with a positive OPG, 8/1 22 (6.60%) vs those with negative OPG (23/1480, 1.6%). However, it was most marked in patients with operable bifurcation lesions (6/67, 9.0% ). Stroke was not increased in patients with carotid occlusion or posi tive OPG without significant carotid bifurcation disease (2/63, 3.20%) . Carotid endarterectomy in patients with operable bifurcation lesions was associated with a decreased (P < 0.05) stroke rate after OHS (1/4 4, 2.30% vs 5/23, 21.7%). Our data suggests identification of signific ant carotid disease and carotid endarterectomy will decrease stroke af ter OHS. (C) 1994 Academic Press, Inc.