A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery

Bruce J. Brener, Donald K. Brief, Joseph Alpert, Robert J. Goldenkranz, Victor Parsonnet, Sheldon M. Feldman, Issac Gielchinsky, Ronald M. Abel, Mark Hochberg, Mansoor Hussain

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

From January 1979 through December 1982, 2026 patients scheduled to undergo open heart surgery were evaluated by a preoperative battery of noninvasive carotid tests including phonoangiography, oculopneumoplethysmography, pulse-timing oculoplethysmography, periorbital Doppler examination, and during the last 12 months, continuous-wave Doppler ultrasonography with spectral analysis. The incidence of hemispheric neurologic deficit following cardiac surgery in the 47 patients with carotid disease was 14.9%; the incidence in patients with no carotid disease was 1.9% (p < 0.001). Fourteen of the 47 patients were not candidates for carotid surgery because of unilateral occlusion in 13 and bilateral occlusion in one. Three of the 14 (21.4%) had intraoperative strokes on the appropriate side. Thirty-three of the 47 had operable carotid disease. Four with unilateral stenosis had no carotid surgery; one had a postoperative deficit on the side referable to the nonstenotic artery. Eighteen with unilateral stenosis underwent simultaneous cardiac and carotid surgery; one (5.6%) had a transient deficit. Seven patients with bilateral stenosis underwent cardic and unilateral carotid surgery; no deficits occurred. Four patients with unilateral stenosis and contralateral occlusion underwent combined surgery; one had a transient ischemic attack and one a fatal stroke, both referable to the hemisphere ipsilateral to the occlusion. It appears that the presence of carotid disease increased the risk of stroke during heart surgery. Proof that carotid endarterectomy lowers this risk awaits a prospective randomized trial.

Original languageEnglish (US)
Pages (from-to)326-338
Number of pages13
JournalJournal of Vascular Surgery
Volume1
Issue number2
DOIs
StatePublished - Jan 1 1984
Externally publishedYes

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Thoracic Surgery
Pathologic Constriction
Stroke
Doppler Ultrasonography
Carotid Endarterectomy
Transient Ischemic Attack
Incidence
Neurologic Manifestations
Pulse
Arteries

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery. / Brener, Bruce J.; Brief, Donald K.; Alpert, Joseph; Goldenkranz, Robert J.; Parsonnet, Victor; Feldman, Sheldon M.; Gielchinsky, Issac; Abel, Ronald M.; Hochberg, Mark; Hussain, Mansoor.

In: Journal of Vascular Surgery, Vol. 1, No. 2, 01.01.1984, p. 326-338.

Research output: Contribution to journalArticle

Brener, BJ, Brief, DK, Alpert, J, Goldenkranz, RJ, Parsonnet, V, Feldman, SM, Gielchinsky, I, Abel, RM, Hochberg, M & Hussain, M 1984, 'A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery', Journal of Vascular Surgery, vol. 1, no. 2, pp. 326-338. https://doi.org/10.1016/0741-5214(84)90065-X
Brener, Bruce J. ; Brief, Donald K. ; Alpert, Joseph ; Goldenkranz, Robert J. ; Parsonnet, Victor ; Feldman, Sheldon M. ; Gielchinsky, Issac ; Abel, Ronald M. ; Hochberg, Mark ; Hussain, Mansoor. / A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery. In: Journal of Vascular Surgery. 1984 ; Vol. 1, No. 2. pp. 326-338.
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