Th. Wareing et al., STRATEGY FOR THE REDUCTION OF STROKE INCIDENCE IN CARDIAC SURGICAL PATIENTS, The Annals of thoracic surgery, 55(6), 1993, pp. 1400-1408
Atherosclerosis of the ascending aorta (AAA) and severe carotid artery
disease are risk factors for stroke in cardiac surgical patients. Twe
lve hundred of a consecutive series of 1,334 patients 50 years of age
or older having a cardiac operation were screened for the presence of
AAA by intraoperative ultrasonographic scanning and for the presence o
f carotid artery occlusive disease (791 of 798 patients greater-than-o
r-equal-to 65 years of age and younger symptomatic patients) by caroti
d duplex scanning. Coronary artery disease was present in 88% of the p
atients. Patients with moderate or severe AAA (n = 231; 19.3% of the t
otal) were treated by ascending aortic replacement (n = 27) or by modi
fied, less extensive techniques (n = 168) to avoid the atherosclerotic
areas. Thirty-three patients had combined carotid endarterectomy and
cardiac operation. Thirty-day mortality and stroke rates for the 1,200
patients were 4.0% and 1.6%, respectively. The stroke rate was low (1
.1%) among the 969 patients with no or mild AAA. It was zero among 27
patients with moderate or severe AAA who had ascending aortic replacem
ent and among the 33 patients who had carotid endarterectomy. The stro
ke rates were higher for 111 patients with moderate or severe ascendin
g aortic disease who had only minor interventions (6.3%) and for 16 pa
tients with severe carotid artery disease who did not have carotid end
arterectomy (18.7%). Screening for AAA and carotid artery disease and
aggressive surgical treatment of moderate or severe AAA and severe or
symptomatic carotid artery disease appears to reduce the frequency of
stroke in older cardiac surgical patients.