The causes of stroke following coronary-artery bypass surgery are largely unknown. To determine whether carotid bruits increase the risk of these events, we compared 54 patients with postoperative stroke or transient ischemic attacks with 54 randomly selected control patients. Both groups were drawn from 5915 consecutive patients who had coronary bypass surgery at our hospital from 1970 to 1984. Carotid bruits were noted preoperatively in 13 patients with postoperative stroke and in 4 control patients. Case-control analysis showed that the presence of carotid bruits increased the risk of stroke or transient ischemic attacks by 3.9-fold (95 percent confidence interval, 1.2 to 12.8; P less than 0.05). This increased risk remained essentially unchanged after adjustment for potentially confounding variables in a multiple logistic regression analysis. Other factors associated with a significantly increased risk (P less than 0.05) of these neurologic deficits were a history of stroke or transient ischemic attack (odds ratio, 6.0; 95 percent confidence interval, 1.6 to 22.1), a history of congestive heart failure (odds ratio, 5.3; confidence interval, 1.6 to 17.0), mitral regurgitation (odds ratio, 4.3; confidence interval, 1.4 to 12.9), postoperative atrial fibrillation (odds ratio, 3.0; confidence interval, 1.4 to 6.7), a cardiopulmonary-bypass pump time of more than two hours (odds ratio, 2.7; confidence interval, 1.1 to 6.7), and a previous myocardial infarction (odds ratio, 2.3; confidence interval, 1.1 to 5.1). We conclude that the presence of carotid bruits increases the risk of stroke after coronary-artery bypass surgery. However, the absolute magnitude of this risk, 2.9 percent, is small and comparable to the reported risk of stroke from carotid endarterectomy.
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Zaman, A. G., Archbold, R. A., Helft, G., Paul, E. A., Curzen, N. P., Mills, P. G.
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Hogue, C. W. Jr, Murphy, S. F., Schechtman, K. B., Davila-Roman, V. G.
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Gaudino, M., Glieca, F., Alessandrini, F., Cellini, C., Luciani, N., Pragliola, C., Schiavello, R., Possati, G.
(1999). Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting. Ann. Thorac. Surg.
67: 1246-1253
[Abstract][Full Text]
Hogue, C. W. JR, Barzilai, B., Davila-Roman, V. G.
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3: 17-24
[Abstract]
Janssen, D. P.B., Noyez, L., van Druten, J. A.M., Skotnicki, S. H., Lacquet, L. K.
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15: 166-172
[Abstract][Full Text]
Ashraf, S., Bhattacharya, K., Zacharias, S., Kaul, P., Kay, P. H., Watterson, K. G.
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66: 1958-1962
[Abstract][Full Text]
Akins, C. W.
(1998). Combined carotid endarterectomy and coronary revascularization operation. Ann. Thorac. Surg.
66: 1483-1484
[Full Text]
Hogue, C. W. Jr, Domitrovich, P. P., Stein, P. K., Despotis, G. D., Re, L., Schuessler, R. B., Kleiger, R. E., Rottman, J. N.
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98: 429-434
[Abstract][Full Text]
Mannheimer, C., Eliasson, T., Augustinsson, L.-E., Blomstrand, C., Emanuelsson, H., Larsson, S., Norrsell, H., Hjalmarsson, A.
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97: 1157-1163
[Abstract][Full Text]
Ommen, S. R., Odell, J. A., Stanton, M. S.
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336: 1429-1434
[Full Text]
Barbut, D., Yao, F.-S. F., Lo, Y.-W., Silverman, R., Hager, D. N., Trifiletti, R. R., Gold, J. P.
(1997). Determination of Size of Aortic Emboli and Embolic Load During Coronary Artery Bypass Grafting. Ann. Thorac. Surg.
63: 1262-1267
[Abstract][Full Text]
Hines, G. L., Scott, W. C., Schubach, S. L., Tyd, D., Wehbe, U.
(1997). Hemodynamically Significant Carotid Disease and Prophylactic Carotid Endarterectomy in CABG Patients Impact on Perioperative Neurologic Events. VASC ENDOVASCULAR SURG
31: 147-151
[Abstract]
Libman, R. B., Wirkowski, E., Neystat, M., Barr, W., Gelb, S., Graver, M.
(1997). Stroke Associated With Cardiac Surgery: Determinants, Timing, and Stroke Subtypes. Arch Neurol
54: 83-87
[Abstract]
D'Agostino, R. S., Svensson, L. G., Neumann, D. J., Balkhy, H. H., Williamson, W. A., Shahian, D. M.
(1996). Screening Carotid Ultrasonography and Risk Factors for Stroke in Coronary Artery Surgery Patients. Ann. Thorac. Surg.
62: 1714-1723
[Abstract][Full Text]
Mickleborough, L. L., Walker, P. M., Takagi, Y., Ohashi, M., Ivanov, J., Tamariz, M.
(1996). RISK FACTORS FOR STROKE IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING. J. Thorac. Cardiovasc. Surg.
112: 1250-1259
[Abstract][Full Text]
Redmond, J. M., Greene, P. S., Goldsborough, M. A., Cameron, D. E., Stuart, R. S., Sussman, M. S., Watkins, L. Jr, Laschinger, J. C., McKhann, G. M., Johnston, M. V., Baumgartner, W. A.
(1996). Neurologic Injury in Cardiac Surgical Patients With a History of Stroke. Ann. Thorac. Surg.
61: 42-47
[Abstract][Full Text]
Barbut, D., Yao, F.S., Hager, D.N., Kavanaugh, P., Trifiletti, R.R., Gold, J.P.
(1996). Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to Monitor Emboli During Coronary Artery Bypass Surgery. Stroke
27: 87-90
[Abstract][Full Text]
Akins, C. W., Moncure, A. C., Daggett, W. M., Cambria, R. P., Hilgenberg, A. D., Torchiana, D. F., Vlahakes, G. J.
(1995). Safety and Efficacy of Concomitant Carotid and Coronary Artery Operations. Ann. Thorac. Surg.
60: 311-317
[Abstract][Full Text]
Mills, S. A.
(1995). Risk Factors for Cerebral Injury and Cardiac Surgery. Ann. Thorac. Surg.
59: 1296-1299
[Abstract][Full Text]
Sotaniemi, K. A.
(1995). Long-Term Neurologic Outcome After Cardiac Operation. Ann. Thorac. Surg.
59: 1336-1339
[Abstract][Full Text]
Barnett, H. J.M., Eliasziw, M., Meldrum, H. E.
(1995). Drugs and Surgery in the Prevention of Ischemic Stroke. NEJM
332: 238-248
[Full Text]
Cebul, R. D., Whisnant, J. P.
(1989). Carotid Endarterectomy. ANN INTERN MED
111: 660-670
[Abstract]
(1988). DOES CAROTID BRUIT PREDICT STROKE AFTER CABG?. JWatch General
1988: 4-4
[Full Text]
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