Association Between SYNTAX Score and Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Graft (CABG)

2020 ◽  
Vol 22 (7) ◽  
Author(s):  
Ahmad Amouzeshi ◽  
Seyyed Ali Moezi Bady ◽  
Vahid Nabati Bonyabadi
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Significant Relationship ◽  
Carotid Artery Stenosis ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Artery Stenosis ◽  
Syntax Score ◽  
Open Heart

Background: Stroke as a complication of open-heart surgery can be a cause of death and widespread disability. Objectives: This study aimed to determine the relationship between the SYNTAX Score and carotid artery stenosis and evaluate patients undergoing open-heart surgery in terms of postoperative complications and mortality in a six-month to two-year follow-up period. Methods: A cross-sectional study was conducted on 113 patients with CAD who underwent open-heart surgery at our hospital from 2016 to 2017. After collecting demographic data, the SYNTAX score, and color Doppler sonography report, the data were recorded and analyzed by SPSS22. Results: In our study, most patients were male and aged between 50 and 70 years. The mean SYNTAX score was 32.667 + 13.668 in the group with significant carotid stenosis, 33.926 + 9.387 in the group with no significant carotid stenosis, and 30.868 + 9.963 in the group without carotid stenosis. The results showed no significant relationship between carotid artery stenosis and the SYNTAX score (P = 0.512) and no significant relationship between the SYNTAX score and surgical complications (P = 0.666). Conclusions: According to the results, there is no significant relationship between the SYNTAX score and various indices related to heart disease, carotid artery stenosis, and postoperative morbidity and mortality. Thus, this index cannot be used to check and follow patients. However, further studies are needed to reach a definitive conclusion.

scholarly journals Doppler Ultrasound Screening For Significant Carotid Artery Stenosis In Cardiac Surgery Patients, Presenting To Hayatabad Medical Complex, Peshawar, Pakistan.

2020 ◽  
Author(s):  
Muhammad Aasim ◽  
Haroon Mustafa ◽  
Raheela Aziz ◽  
Shahzada Hussain ◽  
Muhammad Salman Khan
Keyword(s):  
Carotid Artery ◽  
Doppler Ultrasound ◽  
Carotid Artery Stenosis ◽  
Carotid Arteries ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Artery Stenosis ◽  
Ultrasound Screening ◽  
Open Heart ◽  
Ultrasound Study

Abstract Background: This study aimed to determine the frequency of significant carotid artery stenosis by Doppler Ultrasound screening in patients undergoing open heart surgery.Method: From January 2019 to April 2019, 125 consecutive patients who were booked for open heart surgery, in Hayatabad Medical Complex Peshawar Pakistan, were included in this study. Adult patients aging more than 18years were studied irrespective of the planned cardiac surgical procedure, while pediatric and adolescent patients below the age of 18years were excluded.Using Mindray® DC 70 Color Doppler Ultrasound Scanner, significant carotid artery stenosis was determined by a Radiologist as stenosis of more than 50 % luminal diameter of the carotid artery under study.Results: We studied 250 carotid arteries of 125 patients (87 males and 38 females with age range 19 to 80 years (mean 57.47 years). Significant stenosis was found in 13 patients (10.40 %) with slight male preponderance (7:6).Conclusion: Doppler ultrasound study is a good modality, free of radiation hazards for screening carotid arteries in patients undergoing open Heart surgery. Patients with significant carotid artery stenosis on Doppler ultrasound study may be objectively confirmed by subsequent CT carotid angiography. However, further studies are required to assess the efficiency of Doppler ultrasound study in carotid artery stenosis in comparison to CT carotid angiography.Routine Doppler ultrasound screening in adult cardiac surgical patients can identify significant carotid artery stenosis and can help in subsequently reducing the risk of operative stroke in patients undergoing open heart surgery.

scholarly journals Open heart surgery under extracorporeal circulation in the cases with carotid artery stenosis and evaluation for carotid artery stenting

2014 ◽  
Vol 8 (2) ◽  
pp. 75-82
Author(s):  
Hiroshi KAGAMI ◽  
Naoko OGURA ◽  
Michiyuki MARUYAMA ◽  
Yousuke KASAI ◽  
Masatsugu NAKANO ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Extracorporeal Circulation ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Artery Stenosis ◽  
Open Heart

scholarly journals Carotid artery stenosis – Current evidence and treatment recommendations

2021 ◽  
Vol 5 (1) ◽  
pp. 2514183X2110016
Author(s):  
Mandy D Müller ◽  
Leo H Bonati
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Current Evidence ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Risk Of Death ◽  
Asymptomatic Patients

Background: Carotid artery stenosis is an important cause for stroke. Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic carotid stenosis and to some extent in patients with asymptomatic carotid stenosis. More than 20 years ago, carotid artery stenting (CAS) emerged as an endovascular treatment alternative to CEA. Objective and Methods: This review summarises the available evidence from randomised clinical trials in patients with symptomatic as well as in patients with asymptomatic carotid stenosis. Results: CAS is associated with a higher risk of death or any stroke between randomisation and 30 days after treatment than CEA (odds ratio (OR) = 1.74, 95% CI 1.3 to 2.33, p < 0.0001). In a pre-defined subgroup analysis, the OR for stroke or death within 30 days after treatment was 1.11 (95% CI 0.74 to 1.64) in patients <70 years old and 2.23 (95% CI 1.61 to 3.08) in patients ≥70 years old, resulting in a significant interaction between patient age and treatment modality (interaction p = 0.007). The combination of death or any stroke up to 30 days after treatment or ipsilateral stroke during follow-up also favoured CEA (OR = 1.51, 95% CI 1.24 to 1.85, p < 0.0001). In asymptomatic patients, there is a non-significant increase in death or stroke occurring within 30 days of treatment with CAS compared to CEA (OR = 1.72, 95% CI 1.00 to 2.97, p = 0.05). The risk of peri-procedural death or stroke or ipsilateral stroke during follow-up did not differ significantly between treatments (OR = 1.27, 95% CI 0.87 to 1.84, p = 0.22). Discussion and Conclusion: In symptomatic patients, randomised evidence has consistently shown CAS to be associated with a higher risk of stroke or death within 30 days of treatment than CEA. This extra risk is mostly attributed to an increase in strokes occurring on the day of the procedure in patients ≥70 years. In asymptomatic patients, there may be a small increase in the risk of stroke or death within 30 days of treatment with CAS compared to CEA, but the currently available evidence is insufficient and further data from ongoing randomised trials are needed.

scholarly journals A study on prevalence of carotid artery stenosis in acute ischaemic stroke patients in Amalapuram, Andhra Pradesh, India

2019 ◽  
Vol 7 (6) ◽  
pp. 2146
Author(s):  
Bonthu Mamatha Bharathi ◽  
Raveena Gullapalli
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Acute Onset ◽  
Artery Stenosis ◽  
Doppler Study ◽  
Diastolic Velocity ◽  
Asymptomatic Patients

Background: Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyperlipidemia. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common Various methods includes transcranial doppler (TCD) ultrasonography, cerebral angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Methods: All patients with ischaemic stroke of acute onset admitted in the medical wards of Konaseema institute of medical sciences between June 2018 and January 2019 were included in the study. All patients were subjected to CT scan brain study and colour Doppler study of extra cranial carotid arteries and vertebral arteries. Systolic and diastolic velocity of blood flow, carotid intimal medial thickness, presence of athermanous plaque and thrombus was looked for and then the percentage of stenosis of the affected arteries was calculated.Results: In the present study 0ut of 23 patients with carotid stenosis 9 patients had mild carotid stenosis, 8 patients had moderate stenosis and 6 patients had severe stenosis. Out of 23 patients with carotid stenosis the 11 patients have stenosis in the right carotid and 12 patients had stenosis in the left side. The site of stenosis is ICA in 17 patients and CCA in 6 patients.Conclusions: In present study every patient with carotid artery stenosis had one or the other risk factor for carotid atherosclerosis. In other words, there was no patient with carotid artery stenosis, without any risk factor in present study. Hence asymptomatic patients with these risk factors should be screened for carotid stenosis to prevent stroke.

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Singh ◽  
Tom Stys ◽  
Valerie Bares ◽  
Jeffrey Wilson ◽  
Adam Stys
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Coronary Artery Calcium ◽  
Carotid Artery Stenosis ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Plaque Burden ◽  
Significant Difference

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age <60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p<.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC <100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

Abstract 218: Major Therapeutic Cardiac Procedures in the Very Elderly: All-Payer Race-Gender Disparities and Temporal Trends

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Elizabeth B Pathak ◽  
Amit P Pathak
Keyword(s):  
Hospital Mortality ◽  
White Women ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Temporal Trends ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Very Elderly ◽  
Cardiac Procedures ◽  
Race Ethnicity

Objectives: Major therapeutic cardiac procedures include open heart surgery (e.g., coronary artery bypass graft, valv/septum repairs) (OPEN), insertion/repair of pacemakers, internal defibrillators, and related devices (PACE), and percutaneous coronary intervention (PCI). The use of these procedures among patients aged > 85 years has not been well-described. Methods: Inpatient records for adults aged > 85 years were obtained from a comprehensive all-payer hospital discharge database for Florida for 2006-2011. Major cardiac procedures were identified by ICD-9-CM codes. Patient race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black), gender, payer, principal/secondary diagnoses, and in-hospital mortality were analyzed for each procedure type. Annual procedure rates were calculated using US Census population estimates. Results: There were 2,497,573 person-years at risk for the period 2006-2011, with a total of 1,355,308 inpatient hospitalizations in this very elderly population. Medicare coverage ranged from 88% in Hispanic men (HM) to 96% in White women (WW). Procedure rates were higher in Medicare patients vs. all other payers. PACE was the most common major cardiac procedure (n=32,338), followed by PCI (n=17,046) and OPEN (n=5,916). Population rates of each procedure varied significantly by race/ethnicity and gender (see Figure for PACE rates). In 2011, the rate of PCI for White men (WM) (89 per 10,000, 95% CI 84 to 94) was 20% higher compared to HM, 70% higher compared to Black men (BM), 80% higher than WW and Black women (BW), and 130% higher than Hispanic women (HW). The open heart surgery rate for WM (41 per 10,000, 95% CI 38 to 45) was significantly higher than all other groups: 1.6 times the rate for HM, 2.9 times the rate for WW, 4.1 times the rate for HW, 8.2 times the rate for BM and 10.3 times the rate for BW. In-hospital mortality rates were 1.4% for PACE, 4.3% for PCI, and 8.2% for OPEN. Temporal trends showed declining rates for all procedures over the study period. Conclusions: Major therapeutic cardiac interventions are common among the very elderly. Greater inclusion of very elderly patients in clinical trials and outcome studies is necessary to establish the survival and quality of life benefits of these procedures for patients near the end of life.

scholarly journals Concurrent Carotid Endarterectomy and Off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: A Prospective Cohort Study

2018 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Heemel Saha ◽  
Sabita Mandal ◽  
Sanjoy Kumar Saha ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Stenosis ◽  
Off Pump ◽  
Co Morbidity

A patient of ischemic heart disease (IHD) with additional carotid artery stenosis (CAS) has been distinguished as a high risk group for both heart and cerebral inconveniences following surgical intervention. We aimed to review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass graft (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS at our institute.In the vicinity of 2014 and 2016, fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Six (40%) patients had a history of myocardial infarction (MI), four (26.66%) had unstable angina (USAP), and three (20%) had USAP together with MI, though two (13.33%) were asymptomatic. Nine (60%) patients demonstrated no neurological manifestations, three (20%) had transient ischemic assaults (TIAs), two (13.33%) experienced stroke, and 1 (6.66%) experienced both. Majority 7 (46.66%) patients had 75-90% carotid artery stenosis and 6(40%) patients experienced right though 8 (53.33%) experienced left CEA and only 1 (6.66%) had bilateral CEA. Five (33.33%) patients were found left main disease (>50% lesion) and 100% patients have had significant Left Anterior Descending (LAD) lesion in this study. Twelve (80%) patients show significant lesion in Right Coronary Artery (RCA) and ten (66.66%) patients had Obtuse marginal (OM) branch disease. CEA was performed before OPCABG in all cases. There were 15 patients (mean age 62.5±2.8 years; 80% were male), two (13.33%) had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 h and patients were released in 10 days. There was no mortality in the early postoperative period and co-morbidity was less significant (6.6% myocardial ischemia, 13.33% atrial fibrillation, 6.66% TIA, 13.33% Stroke). There was 1 (6.66%) postoperative acute renal failure evidenced by raised serum creatinine level. Two (13.33%) patients showed respiratory complications; only 6.6% of them suffered from wound infection. A combined strategy by means of CEA with OPCABG is safe and savvy in view of the satisfactory consequences of morbidity and mortality rates and also short ICU and hospital stay status.Faridpur Med. Coll. J. Jan 2018;13(1): 2-7

scholarly journals Predictors of the pulsatility index in the middle cerebral artery of acute stroke patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Olivier Bill ◽  
Dimitris Lambrou ◽  
Guillermo Toledo Sotomayor ◽  
Ivo Meyer ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Carotid Stenosis ◽  
Flow Pattern ◽  
Cerebral Artery ◽  
Carotid Artery Stenosis ◽  
Pulsatility Index ◽  
Artery Stenosis ◽  
Doppler Velocity ◽  
High Grade

Abstract Cervical and transcranial Doppler (TCD) are widely used as non-invasive methods in the evaluation of acute ischemic stroke (AIS) patients. High-grade carotid artery stenosis induces haemodynamic changes such as collateral flow and a so-called post-stenotic flow pattern of the middle cerebral artery (MCA), which appears flattened, with a reduction of the velocity difference between systole and diastole. We studied the influence of carotid artery stenosis and other variables on the flow pattern in the MCA using the pulsatility index (PI), a quantitative TCD parameter reflecting the flow spectrum in a large of cohort AIS patients. We performed ultrasound examinations of 1825 AIS patients at the CHUV from October 2004 to December 2014. We extracted patient characteristics from the ASTRAL registry. Carotid stenosis severity was classified as < 50%, 50–70%, 70–90% and > 90%, or occlusion, according to Doppler velocity criteria. We first determined variables associated with stenosis grade. Then we performed a multivariate analysis after adjusting for baseline differences, using MCA PI as dependent variable. Carotid stenosis > 70% (− 0.07) and carotid stenosis > 90%, or occlusion (− 0.14) and left side (− 0.02) are associated with lower MCA PI values. Age (+0.006 PI units per decade), diabetes (+0.07), acute ischemic changes on initial CT (+0.03) and severe plaque morphology (+0.18) are associated with higher MCA PI values. We found a number of clinical and radiological conditions that significantly influence the PI of the MCA, including high-grade ipsilateral carotid stenosis in AIS patients. We provide for the first time a quantitative evaluation of the effect of these influencing factors from a large cohort of AIS patients.

scholarly journals Impairments in Brain Perfusion, Metabolites, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients: An Integrated MRI Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Tao Wang ◽  
Feng Xiao ◽  
Guangyao Wu ◽  
Jian Fang ◽  
Zhenmeng Sun ◽  
...  
Keyword(s):  
Executive Function ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Anterior Part ◽  
Brain Perfusion ◽  
Posterior Cingulate Cortex ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Carotid artery stenosis without transient ischemic attack (TIA) or stroke is considered as “asymptomatic.” However, recent studies have demonstrated that these asymptomatic carotid artery stenosis (aCAS) patients had cognitive impairment in tests of executive function, psychomotor speed, and memory, indicating that “asymptomatic” carotid stenosis may not be truly asymptomatic. In this study, when 19 aCAS patients compared with 24 healthy controls, aCAS patients showed significantly poorer performance on global cognition, memory, and executive function. By utilizing an integrated MRI including pulsed arterial spin labeling (pASL) MRI, Proton MR Spectroscopy (MRS), and resting-state functional MRI (R-fMRI), we also found that aCAS patients suffered decreased cerebral blood flow (CBF) mainly in the Left Frontal Gyrus and had decreased NAA/Cr ratio in the left hippocampus and decreased connectivity to the posterior cingulate cortex (PCC) in the anterior part of default mode network (DMN).

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