Hemispheric stroke following cardiac surgery: A case-control estimate of the risk resulting from ipsilateral asymptomatic carotid artery stenosis

A case-control study was undertaken to determine if asymptomatic carotid ar tery stenosis (ACS) is independently associated with ipsilateral hemispheri c stroke following cardiac surgery (CS). All CS patients (3069) who were at two hospitals between 1989 and 1994 were reviewed. Cases (31) selected for this study were those with hemispheric stroke within 30 days following CS. Controls (69) were taken from those without hemispheric stroke. Case-contr ol analysis demonstrated that ACS of 50-90% and of 80-90% increased the ris k of ipsilateral stroke 5.2-fold (95% confidence interval [CI] = 1.5-16.3, p = 0.01) and 24.3-fold (CI = 2.6-114.9, p = 0.002), respectively. Other va riables with significant odds ratios (OR) were age greater than or equal to 65 years (OR = 4.0, CI = 1.3-10.5, p = 0.01), peripheral Vascular disease (OR = 3.4, CI = 1.3-8.8, p = 0.02), hypertension (OR = 3.0, CI = 1.2-7.0, p = 0.02), and female gender (OR = 3.0, CI = 1.2-7.1, p = 0.04), A second co nservative analysis for missing data demonstrated a significant association for ACS of 80-90% alone (OR = 13.1, CI = 1.5-60.9, p = 0.01). This associa tion remained significant after multivariate adjustment with propensity sco re stratification. ACS (80-90%) appears to be independently associated with ipsilateral hemispheric stroke following CS when evaluated against the pre sent study variables. This finding supports the need for a properly conduct ed prospective natural history study, including an evaluation of aortic arc h atherosclerosis, to determine the clinical relevance of this observation. DOI:10.1007/s100169910036.