INFLUENCE OF CAROTID ATHEROMATOUS DISEASE ON POSTOPERATIVE NEUROLOGICRECOVER IN MYOCARDIAL REVASCULARIZATION

Surgical management of the carotid disease remains controversial in pa tients affected with coronary artery atheromatous disease, We report t he Montreal Heart Institute experience on the influence of carotid dis ease on postoperative neurologic events of 501 consecutive patients op erated on for coronary revascularization during the period from Januar y 1994 to December 1994. There were 381 men and 114 women averaging 62 +/- 9 years old, Major risk factors were high blood pressure (35%), a nd smoking habit (48%). Fifty-nine patients presented clinical signs o f carotid atheromatosis and among them 21 had significant carotid sten osis (> 80% decrease of cross sectional area). During surgery, the mea n duration of extracorporeal circulation (ECC) was 76 +/- 31 minutes a nd the mean perfusion pressure (MPP) was 70 +/- 11 mmHg. The use of in otropic drugs was mandatory in 26% of the cases and the mean arterial lactate (AL) dosage during ECG was 3.07 +/- 1.35 mM/L. During the peri operative period, 13 (2.5%) patients sustained neurologic disturbances of which 5 (1%) were lateralized. Among them, 8 completely recovered whereas 3 of the 5 with permanent damage died. None of the patients wi th preoperative stigmata of carotid disease experienced lateralized ne urologic deficit. Multivariate regression analysis identified the use of vasopressor drugs and perioperative increase of AL as predictive fa ctors. We conclude that in our series, the incidence of neurologic com plications was low. The presence of carotid atheromatosis did not incr ease the postsurgical risk of cerebrovascular accident, however, the i ncreased incidence of neurologic events associated with inotropic drug s and increased AL suggests a direct link with a systemic oxygen debt. Consequently, we do not recommend concurrent prophylactic surgery dur ing coronary artery revascularization.