Central nervous system complications in patients with carotid artery stenosis undergoing off-pump coronary artery bypass grafting: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yalin ¹ , DENG Hao ¹ ,  YANG Sumin ² , WU Yuhui ² , ZHANG Hong ² , WANG Jinping ²

1. Department of Medicine, Qingdao University, Qingdao, 266003, Shandong, P. R. China;
2. Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, P. R. China;

Corresponding author：

YANG Sumin, Email: yangsumin5850@sina.com

Keywords：

Carotid artery stenosis; off-pump coronary artery bypass grafting; central nervous system complications; risk factors

DOI：

10.7507/1007-4848.202108049

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Objective To analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting (OPCABG) and explore the influencing factors. Methods A total of 1 150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications, including a central nervous system complication group [n=61, 43 males and 18 females with a median age of 68.0 (63.0, 74.0) years] and a non-central nervous system complication group [n=1 089, 796 males and 293 females with a median age of 65.5 (59.0, 70.0) years]. The risk factors for central nervous system complications after OPCABG were analyzed. Results Univariate analysis showed that age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intra-aortic ballon pump (IABP), postoperative arrhythmia, postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications. The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion (11.63%) was higher than that in the non-stenosis and mild stenosis patients (4.80%) and moderate stenosis patients (4.76%) with a statistical difference (P=0.038). The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation (42.11% vs. 2.99%, P<0.001). Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications (P<0.05). Conclusion The age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intraoperative use of IABP, postoperative arrhythmia, secondary thoracotomy after surgery, blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients. Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications. In patients with severe carotid artery stenosis, preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.

Citation： LIU Yalin, DENG Hao, YANG Sumin, WU Yuhui, ZHANG Hong, WANG Jinping. Central nervous system complications in patients with carotid artery stenosis undergoing off-pump coronary artery bypass grafting: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 736-741. doi: 10.7507/1007-4848.202108049 Copy

1.	Kanchi M, Manjunath R, Maessen J, et al. Effect of sodium bicarbonate infusion in off-pump coronary artery bypass grafting in patients with renal dysfunction. J Anaesthesiol Clin Pharmacol, 2018, 34(3): 301-306.
2.	Kirmani BH, Holmes MV, Muir AD. Long-term survival and freedom from reintervention after off-pump coronary artery bypass grafting: A propensity-matched study. Circulation, 2016, 134(17): 1209-1220.
3.	Xu B, Qiao Q, Chen M, et al. Relationship between neurological complications, cerebrovascular and cerebral perfusion following off-pump coronary artery bypass grafting. Neurol Res, 2015, 37(5): 421-426.
4.	Shroyer AL, Grover FL, Hattler B, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med, 2009, 361(19): 1827-1837.
5.	Bhaskaran K, Arumugam G, Vinay Kumar PV. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries. Ann Card Anaesth, 2018, 21(4): 413-418.
6.	Wang B, Jia M, Jia S, et al. Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting. Heart Lung Circ, 2014, 23(6): 560-565.
7.	李勇新, 刘淼淼, 张永健, 等. 冠状动脉旁路移植术后患者发生谵妄的相关因素. 心脑血管病防治, 2017, 17(6): 461-462,466.
8.	Caldas JR, Panerai RB, Bor-Seng-Shu E, et al. Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: An analysis of the IABCS trial. Ann Intensive Care, 2019, 9(1): 130.
9.	Mikkola R, Gunn J, Heikkinen J, et al. Use of blood products and risk of stroke after coronary artery bypass surgery. Blood Transfus, 2012, 10(4): 490-501.
10.	Mehta A, Choxi R, Gleason T, et al. Carotid artery disease as a predictor of in-hospital postoperative stroke after coronary artery bypass grafting from 1999 to 2011. J Cardiothorac Vasc Anesth, 2018, 32(4): 1587-1596.
11.	Narayan P, Khan MW, Das D, et al. Carotid artery screening at the time of coronary artery bypass—Does it influence neurological outcomes? Int J Cardiol, 2017, 243: 140-144.
12.	Toyama S, Matsuoka K, Tagaito Y, et al. Retrospective evaluation of the effect of carotid artery stenosis on cerebral oxygen saturation during off-pump coronary artery bypasses grafting in adult patients. BMC Anesthesiol, 2015, 15: 180.
13.	Brinjikji W, Rabinstein AA, Lanzino G, et al. Ultrasound characteristics of symptomatic carotid plaques: A systematic review and meta-analysis. Cerebrovasc Dis, 2015, 40(3-4): 165-174.
14.	Paraskevas KI, Mikhailidis DP, Veith FJ. Comparison of the five 2011 guidelines for the treatment of carotid stenosis. J Vasc Surg, 2012, 55(5): 1504-1508.
15.	Feldman DN, Swaminathan RV, Geleris JD, et al. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv, 2017, 10(3): 286-298.
16.	Imasaka K, Yasaka M, Tayama E, et al. Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: A study on brain perfusion single-photon emission computed tomography with acetazolamide. Eur J Cardiothorac Surg, 2015, 48(5): 739-746.
17.	Mo D, Luo G, Wang B, et al. Staged carotid artery angioplasty and stenting for patients with high-grade carotid stenosis with high risk of developing hyperperfusion injury: A retrospective analysis of 44 cases. Stroke Vasc Neurol, 2016, 1(4): 147-153.
18.	Kawabori M, Kuroda S, Terasaka S, et al. Therapeutic strategies for patients with internal carotid or middle cerebral artery occlusion complicated by severe coronary artery disease. World Neurosurg, 2010, 73(4): 345-350.
19.	Al-Hashel JY, Al-Sabah AA, Ahmed SF, et al. Risk factors, subtypes, and outcome of ischemic stroke in Kuwait: A national study. J Stroke Cerebrovasc Dis, 2016, 25(9): 2145-2152.
20.	Mangi AR, Zia K, Ali TA, et al. Postoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting. Cureus, 2019, 11(3): e4333.
21.	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
22.	Demir G, Çukurova Z, Eren G, et al. Comparison of the effects of on-pump and off-pump coronary artery bypass surgery on cerebral oxygen saturation using near-infrared spectroscopy. Korean J Anesthesiol, 2014, 67(6): 391-397.
23.	Miyazaki S, Yoshitani K, Miura N, et al. Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact Cardiovasc Thorac Surg, 2011, 12(3): 379-383.

1. Kanchi M, Manjunath R, Maessen J, et al. Effect of sodium bicarbonate infusion in off-pump coronary artery bypass grafting in patients with renal dysfunction. J Anaesthesiol Clin Pharmacol, 2018, 34(3): 301-306.
2. Kirmani BH, Holmes MV, Muir AD. Long-term survival and freedom from reintervention after off-pump coronary artery bypass grafting: A propensity-matched study. Circulation, 2016, 134(17): 1209-1220.
3. Xu B, Qiao Q, Chen M, et al. Relationship between neurological complications, cerebrovascular and cerebral perfusion following off-pump coronary artery bypass grafting. Neurol Res, 2015, 37(5): 421-426.
4. Shroyer AL, Grover FL, Hattler B, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med, 2009, 361(19): 1827-1837.
5. Bhaskaran K, Arumugam G, Vinay Kumar PV. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries. Ann Card Anaesth, 2018, 21(4): 413-418.
6. Wang B, Jia M, Jia S, et al. Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting. Heart Lung Circ, 2014, 23(6): 560-565.
7. 李勇新, 刘淼淼, 张永健, 等. 冠状动脉旁路移植术后患者发生谵妄的相关因素. 心脑血管病防治, 2017, 17(6): 461-462,466.
8. Caldas JR, Panerai RB, Bor-Seng-Shu E, et al. Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: An analysis of the IABCS trial. Ann Intensive Care, 2019, 9(1): 130.
9. Mikkola R, Gunn J, Heikkinen J, et al. Use of blood products and risk of stroke after coronary artery bypass surgery. Blood Transfus, 2012, 10(4): 490-501.
10. Mehta A, Choxi R, Gleason T, et al. Carotid artery disease as a predictor of in-hospital postoperative stroke after coronary artery bypass grafting from 1999 to 2011. J Cardiothorac Vasc Anesth, 2018, 32(4): 1587-1596.
11. Narayan P, Khan MW, Das D, et al. Carotid artery screening at the time of coronary artery bypass—Does it influence neurological outcomes? Int J Cardiol, 2017, 243: 140-144.
12. Toyama S, Matsuoka K, Tagaito Y, et al. Retrospective evaluation of the effect of carotid artery stenosis on cerebral oxygen saturation during off-pump coronary artery bypasses grafting in adult patients. BMC Anesthesiol, 2015, 15: 180.
13. Brinjikji W, Rabinstein AA, Lanzino G, et al. Ultrasound characteristics of symptomatic carotid plaques: A systematic review and meta-analysis. Cerebrovasc Dis, 2015, 40(3-4): 165-174.
14. Paraskevas KI, Mikhailidis DP, Veith FJ. Comparison of the five 2011 guidelines for the treatment of carotid stenosis. J Vasc Surg, 2012, 55(5): 1504-1508.
15. Feldman DN, Swaminathan RV, Geleris JD, et al. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv, 2017, 10(3): 286-298.
16. Imasaka K, Yasaka M, Tayama E, et al. Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: A study on brain perfusion single-photon emission computed tomography with acetazolamide. Eur J Cardiothorac Surg, 2015, 48(5): 739-746.
17. Mo D, Luo G, Wang B, et al. Staged carotid artery angioplasty and stenting for patients with high-grade carotid stenosis with high risk of developing hyperperfusion injury: A retrospective analysis of 44 cases. Stroke Vasc Neurol, 2016, 1(4): 147-153.
18. Kawabori M, Kuroda S, Terasaka S, et al. Therapeutic strategies for patients with internal carotid or middle cerebral artery occlusion complicated by severe coronary artery disease. World Neurosurg, 2010, 73(4): 345-350.
19. Al-Hashel JY, Al-Sabah AA, Ahmed SF, et al. Risk factors, subtypes, and outcome of ischemic stroke in Kuwait: A national study. J Stroke Cerebrovasc Dis, 2016, 25(9): 2145-2152.
20. Mangi AR, Zia K, Ali TA, et al. Postoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting. Cureus, 2019, 11(3): e4333.
21. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
22. Demir G, Çukurova Z, Eren G, et al. Comparison of the effects of on-pump and off-pump coronary artery bypass surgery on cerebral oxygen saturation using near-infrared spectroscopy. Korean J Anesthesiol, 2014, 67(6): 391-397.
23. Miyazaki S, Yoshitani K, Miura N, et al. Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact Cardiovasc Thorac Surg, 2011, 12(3): 379-383.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Central nervous system complications in patients with carotid artery stenosis undergoing off-pump coronary artery bypass grafting: A retrospective cohort study

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