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Hemispheric stroke following cardiac surgery: a case-control estimate of the risk resulting from ipsilateral asymptomatic carotid artery stenosis.

Abstract：

:A case-control study was undertaken to determine if asymptomatic carotid artery stenosis (ACS) is independently associated with ipsilateral hemispheric stroke following cardiac surgery (CS). All CS patients (3069) who were at two hospitals between 1989 and 1994 were reviewed. Cases (31) selected for this study were those with hemispheric stroke within 30 days following CS. Controls (69) were taken from those without hemispheric stroke. Case-control analysis demonstrated that ACS of 50-90% and of 80-90% increased the risk of ipsilateral stroke 5.2-fold (95% confidence interval [CI] = 1.5-16.3, p = 0.01) and 24.3-fold (CI = 2.6-114.9, p = 0.002), respectively. Other variables with significant odds ratios (OR) were age > or =65 years (OR = 4.0, CI = 1.3-10.5, p = 0.01), peripheral vascular disease (OR = 3.4, CI = 1.3-8.8, p = 0.02), hypertension (OR = 3.0, CI = 1.2-7.0, p = 0.02), and female gender (OR = 3.0, CI = 1.2-7.1, p = 0.04). A second conservative analysis for missing data demonstrated a significant association for ACS of 80-90% alone (OR = 13.1, CI = 1.5-60.9, p = 0.01). This association remained significant after multivariate adjustment with propensity score stratification. ACS (80-90%) appears to be independently associated with ipsilateral hemispheric stroke following CS when evaluated against the present study variables. This finding supports the need for a properly conducted prospective natural history study, including an evaluation of aortic arch atherosclerosis, to determine the clinical relevance of this observation.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Hill AB,Obrand D,O'Rourke K,Steinmetz OK,Miller N

doi

10.1007/s100169910036

subject

Has Abstract

pub_date

2000-05-01 00:00:00

pages

200-9

issue

3

eissn

0890-5096

issn

1615-5947

pii

10.1007/s100169910036

journal_volume

14

pub_type

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