1. Risk of post-operative stroke in patients with known extra-cranial carotid artery disease undergoing Non-Cardiac Surgery Heart and Vascular institute, Department of Vascular medicine Cleveland Clinic Florida, Weston FL
Rajmohan Rammohan MD; Mehrdad Mac Farid MD; Craig Asher MD; Edward Savage MD
BACKGROUND
TABLE 2 DEMOGRAPHICS
Stroke is a devastating complication and may occur in higher rate after surgical procedures. Post-operative mortality rate associated with stroke could be as high as 26% 1compared to 12.6% in non-surgical setting.
The incidence of stroke has been well documented after cardiac surgery ranging from 1.4% to 4.3%2 however risk of post-operative stroke after non-cardiac surgery has not well investigated in current medical literature.
RIGHT SIDE STENOSIS
LEFT SIDE STENOSIS
VARIABLE
<20%stenosis (n=177)
>60% stenosis (n=73)
P VALUE
<20%stenosis (n=187)
>60% stenosis (n=75)
COMORBIDITIES
HYPERTENSION
114(64.4%)
51(69%) NS
115(61.4%)
54(72%)
0.12
HYPERLIPIDEMIA
115(87.5%)
47(64%)
119(63.6%)
49(65%)
DIABETES MELITUS
68(38.4%)
20(73%)
70(37.4%)
25(33%)
0.52
ATRIAL FIBRILLATION
13(7%)
7(9%)
0.72
12(6%)
6(8%)
0.82
OBJECTIVE
Study primarily aimed to examine if any correlation between carotid artery stenosis and incidence rate of post-operative stroke may exist and secondarily to examine if any association between incidence of post-operative stoke and degree of carotid stenosis may exist.
METHOD & DISCUSSION
GRAPHICAL DISTRIBUTION OF SURGERY
After the Institutional Board Review approval, we retrospectively reviewed database of patients who underwent variety of non-cardiac surgeries or procedures with a known carotid artery stenosis.
All individuals had carotid artery ultrasonography revealing variable degree of stenosis detected at least within 2 years prior to surgery.
Patients were included only if underwent a procedure requiring general anesthesia.
All carotids were studied by a certified vascular lab technologist using IU 22 Philips Ultrasound units.
TABLE 1 : DISTIBUTION OF SURGERY RISK :
944 carotids identified in 472 patients (male: 56.1%, female 43.8%) with an average age of 71.6±9.8. From total population 324 (68%) were identified with hypertension, 319 with hyperlipidemia (67%), 187 with diabetes mellitus (39%).
117 carotids had 60-79% (53.9% left, 46.1% right), 15 had critical stenosis over 80% (40% left, 60% right) and 16 carotids had total occlusion (37.5% left, 62.5% right) .
A complete neurological evaluation was performed within 2 weeks after surgery. No statistically significant stroke rate was reported post-operatively in patients with carotid stenosis including those with total carotid occlusion.
Surgical risk
Carotid
<20%
20-39%
40-59%
60-79%
80-99%
100%
Total
High
Right 50 52 15 19 2
140
Left 57 13 21 1 3
147
Moderate
122 94 32 8
309
125
103 41 37 4
313
Low 5 18 17
364
308
124
117 16
944
CONCLUSIONS
Non-cardiac surgery poses no significant risk for post-operative adverse neurological event in patients with extra-cranial carotid artery stenosis. Further large scale prospective studies may be require to confirm validity of suggested outcome
REFERENCES
Parikh S, Perioperative stroke after general surgical procedure NY State J Med 1993;93:162-5
El-Saed A, Geographic variation in stroke incidence and mortality among older population in four US communities. Stroke 2006;37:1975-9
The authors have nothing to disclose