Background. Stroke has been associated with a significantly increased morta
lity from coronary artery bypass grafting (CABG). To determine the predicto
rs of stroke in patients undergoing CABG, we collected data on 472 consecut
ive patients.
Methods. From March 1991 to March 1999, all patients undergoing CABG at our
institution underwent routine duplex scanning of the extracranial carotid
and vertebral arteries. Seven patients with symtomatic carotid stenosis wer
e treated by carotid endarterectomy (CEA) before CABG.
Results. There was a 10-fold increase in mortality (12.5%) associated with
postoperative stroke. Many variables were analyzed by a mutivariate techniq
ue and the severity of extracranial carotid artery stenosis was determined
to be the only independent predictor of postoperative stroke (p < 0.01). No
ne of the patients with carotid artery occlusion and none of the patients w
ho underwent CEA before CABG experienced a stroke.
Conclusions. To reduce the stroke rate, the indications for prophylactic CE
A may be extended for asymptomatic patients with carotid artery stenosis gr
eater than 75%. (Ann Thorac Surg 2000;70:1571-6) (C) 2000 by The Society of
Thoracic Surgeons.