Lescan Mario, Steger Volker, Andic Mateja, Veseli Kujtim, Haeberle Helene, Krüger Tobias, Schlensak Christian
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Hoppe-Seyler Strasse 3, D-72076, Tübingen, Germany.
Department of Anesthesiology, University Medical Center Tübingen, Tübingen, Germany.
Heart Vessels. 2019 Sep;34(9):1471-1478. doi: 10.1007/s00380-019-01381-6. Epub 2019 Mar 23.
The aim was to evaluate the incidence of stroke in the setting of cardiac surgery with or without hemodynamically relevant asymptomatic carotid stenosis contralateral to the occlusion. We designed a historical cohorts study, focused on patients with unilateral totally occluded internal carotid arteries who were referred for any cardiac surgery at our center. Isolated unilateral occlusions were assigned to group 1 (n = 60), and those with a contralateral stenosis grade ≥ 60% were included in group 2 (n = 51). A total of 111 patients operated in our center from 1997 to 2016 were included. Patients in group 2 had an asymptomatic contralateral internal carotid artery stenosis with a mean stenosis grade of 71 ± 20%. Simultaneous carotid endarterectomy (CEA) was performed in 22 patients from group 2. The overall mortality was 8/111 (7.2%). Carotid-associated mortality was not observed, whereas an overall stroke incidence of 8/111 (7.2%) was detected. The group-related outcome showed comparable results for mortality (group 1: 4/60 (6.7%) vs. group 2: 4/51 (7.8%); p = 1.0). Regarding stroke incidence, group 2 had a higher incidence of overall strokes (2/60 (3.3%) vs. 6/51 (11.8%); p = 0.14) with more contralateral (0/60 (0%) vs. 2/51 (3.9%); p = 0.209) and ipsilateral strokes (2/60 (3.3%) vs. 4/51 (7.8%); p = 0.411). Stroke rate peaked in patients with simultaneous carotid and cardiac surgery (n = 22; 18.2%; p = 0.048). Performing simultaneous CEA during cardiac surgery in the presence of a contralateral occlusion may promote stroke. Asymptomatic contralateral carotid stenosis is a risk factor for stroke in patients with carotid occlusion prior to cardiac surgery.
目的是评估在有或无与血流动力学相关的无症状性颈动脉狭窄（与闭塞侧对侧）的心脏手术背景下中风的发生率。我们设计了一项历史性队列研究，聚焦于在我们中心接受任何心脏手术的单侧颈内动脉完全闭塞的患者。单纯单侧闭塞的患者被分配到第1组（n = 60），对侧狭窄程度≥60%的患者被纳入第2组（n = 51）。纳入了1997年至2016年在我们中心接受手术的总共111例患者。第2组患者存在无症状性对侧颈内动脉狭窄，平均狭窄程度为71±20%。第2组的22例患者同时进行了颈动脉内膜切除术（CEA）。总死亡率为8/111（7.2%）。未观察到与颈动脉相关的死亡率，而检测到总的中风发生率为8/111（7.2%）。组间相关结果显示死亡率相当（第1组：4/60（6.7%）对第2组：4/51（7.8%）；p = 1.0）。关于中风发生率，第2组总的中风发生率更高（2/60（3.3%）对6/51（11.8%）；p = 0.14），对侧中风更多（0/60（0%）对2/51（3.9%）；p = 0.209），同侧中风也是如此（2/60（3.3%）对4/51（7.8%）；p = 0.411）。中风发生率在同时进行颈动脉和心脏手术的患者中达到峰值（n = 22；18.2%；p = 0.048）。在存在对侧闭塞的情况下，心脏手术期间同时进行CEA可能会促使中风发生。无症状性对侧颈动脉狭窄是心脏手术前存在颈动脉闭塞的患者中风的一个危险因素。
