Screening for Cerebrovascular Risk in Patients Undergoing Coronary and Carotid Surgery

摘要

Strokes are the second main complication of coronary by-pass surgery (CABG)(l-2) involving from 1 to 6 % of operated patients (3) and are the most common major complication of carotid endarterectomy (4). In patients undergoing CABG the incidence of intraoperatory cerebral ischemia can widely vary from 0.8% to 9% (5), the prevalence of carotid disease is high (6) raising Ihc risk of stroke even in asymptomatic subjects (7). Although it had been previously suggested that combined coronary artery bypass grafting and carotid endarterectmy may be associated with a higher risk of stroke or death than staged procedures (8), more recent data indicate that outcomes for staged and synchronous carotid and coronary surgery do not differ (9). A metanalysis of 56 reviews on the three possible kinds of surgical procedures (simultaneous carotid and coronary procedures, endarterectomy before by-pass and endarterecomty after by-pass) has shown that the first two surgical strategies have a similar incidence of perioperative stroke, while the incidence statistically higher in the third (10).