Off-Pump Coronary Artery Bypass Surgery Reduces Perioperative Stroke Rate in Patients with Asymptomatic Internal Carotid Artery Stenosis

Objectives: Significant internal carotid artery (ACI) is associated with the increased perioperative stroke rate in patients undergoing coronary artery bypass grafting (CABG). The optimal management of patients undergoing CABG with concomitant significant carotid artery stenosis remains controversial. The aim of our study was to investigate whether OPCAB surgery can reduce the perioperative stroke rate in patients with severe asymptomatic ACI stenosis when compared with on-pump CABG (ONCAB).

Methods: We have performed a retrospective data-base analysis of patients undergoing isolated CABG operated between July 2009 and October 2018. A total of 10,613 patients were included of which 243 patients had confirmed severe ACI stenosis without history of stroke. The patients with severe ACI stenosis were allocated in two groups based on the surgical technique used (ONCAB = 92) vs. OPCAB = 151). To correct for the baseline differences, we performed matched propensity score analysis considering 25 baseline characteristics what resulted in 78 pairs.

The primary outcome was perioperative stroke rate. The secondary outcomes were all cause in-hospital mortality, postoperative delirium, intensive care unit (ICU) and hospital length of stay.

Result:

Outcomes	PS-matched sample (n = 156)			p
	On-Pump (n = 78)	OPCAB (n = 78)	OR (95% CI)
Primary outcomePerioperative stroke	8 (10.3%)	1 (1.3%)	0.1 (0.01–0.9)	0.03
Secondary outcomesPostoperative delirium, n (%)	5 (6.4%)	8 (10.3%)	1.7 (0.5–3.7)	0.39
In-hospital mortality, n (%)	3 (3.8%)	3 (3.8%)	1.0 (0.2–5.1)	1.00
ICU stay (days)	1.0 (3.1–0.3)	1.0 (2.7–8.9)	1.0 (0.9–1.1)	0.94
Hospital stay (days)	13.0 (13.8–18.4)	12 (13.4–19.0)	1.0 (0.9–1.1)	0.51

Conclusion: OPCAB surgery significantly reduced perioperative stroke rate in patients with severe asymptomatic ACI stenosis. OPCAB surgery may be considered as the technique of choice for patients with severe asymptomatic ACI stenosis undergoing isolated CABG.

Publication History

Article published online:
19 February 2021