ABSTRACT
Background: Prevalence of carotid artery stenosis is high in patients with coronary artery disease in the western countries as well as in some Asian nations and this increases the risk of stroke in the coronary artery disease patients while undergoing coronary artery bypass grafting [CABG]
Objective: The objective of this study was to determine the frequency of severe carotid artery stenosis in diabetic patients undergoing coronary artery bypass grafting
Patients and Methods: It was a cross-sectional study, conducted in Cardiology department, Punjab Institute of Cardiology, Lahore, from 15[th] December 2006 to 15[th] June 2007. One hundred consecutive diabetic patients undergoing CABG were included in the study. They were diagnosed diabetic on history [previously diagnosed and taking medicine for diabetes] and new diabetic patients diagnosed on laboratory investigations by using criteria; [fasting plasma glucose level 126 mg/dl or higher on more than one occasion]. Type of diabetes, physical examination [carotid bruit] and coronary angiogram findings were noted. Carotid Doppler scan was done in all study population and the severe carotid artery stenosis was diagnosed with the help of Doppler diagnostic criteria that was peak systolic velocity of > 2.3 ml sec of ICA or peak diastolic velocity of >0.75 m/sec of ICA or ICA/CCA systolic ratio of >3 and confirmed by two cardiologists. Data was entered on the proforma, and analyzed in SPSS version 11
Results: The mean age of study subjects was 59.5 +/- 8.4 years, total of 100 patients were included in study. Severe carotid artery stenosis i.e. > 70% stenosis in the carotid arteries was diagnosed in 7% of the study population which were at higher risk for the perioperative neurological complications. Out of these 7 patients, > 70% right carotid stenosis was seen in 2 patients while the remaining 5 patients showed > 70% stenosis of the left carotid artery. We also observed that 7 patients who were diagnosed with severe carotid artery stenosis also had significant associated LMS disease. Out of these, 4 patients [57.1 %] had severe LMS while 2 patients [28.6 %] had moderate LMS disease
Conclusion: A high incidence of severe carotid artery disease was found by using Doppler ultrasound in diabetic patients with TVD or LMCA disease. There was significant association of severe carotid artery stenosis in patients who had severe LMCA disease. Carotid doppler can be used as a screening test to rule out significant carotid artery disease