The influence of carotid artery stenosis on neurological outcomes in patients undergoing off-pump coronary artery bypass grafting / 中华内科杂志

ABSTRACT

ObjectiveTo investigate the influence of carotid artery stenosis on the incidence of neurological complication in patients undergoing off-pump coronary artery bypass grafting.MethodsWe prospectively analyzed 176 consecutive patients ≥60 years old undergoing selective off-pump coronary artery bypass grafting (from June 2010 to July 2011 ).Carotid duplex ultrasound screening was used to determine the presence and severity of carotid artery before surgery. Neurological complications 7 days after surgery were compared between the patients with ( ≥75％ ) and without severe carotid artery stenosis ( ＜ 70％ ).Multivariate analysis was used to determine the predictor of severe carotid artery disease.ResultsSixteen patients (9.1％ ) were found to have severe carotid artery stenosis before surgery. Thirty-seven patients (20.8％ ) had single or multiple neurological complications1 (0.6％ ) had stroke; 12 (6.7％) had hypoxic-metabolic encephalopathy; 21 ( 11.8％ ) had cognitive dysfunction; 3 ( 1.7％ ) had depression.When compared with the counterparts,patients with severe carotid artery stenosis had a higher rate of neurological complications (43.8％ vs 18.8％ ; P =0.044).In multivariate analysis,significant predictive factor for severe carotid artery stenosis was prior stroke ( OR4.04 ; 95％ CI 1.22-13.37 ).Conclusion Severe carotid artery stenosis alone is a risk factor for neurological complication after off-pump coronary artery bypass grafting and prior stroke is a predictor for sever carotid artery disease.