Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups


  • Mehmet Işık Department of Cardiovascular Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
  • Yusuf Velioğlu Department of Cardiovascular Surgery, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey



CABG, carotid artery sitenosis, stroke, carotid endarterectomy, coronary artery disease


Objective: The aim of this study was to contribute to the issue of “Who should we perform Doppler ultrasonography on?” and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and preoperative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke.

Method: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed.

Results: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE.

Conclusion: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.


Aboyans V, Lacroix P. 2009. Indications for carotid screening in patients with coronary artery disease. Presse Med. 38:977-86.

Anzidei M, Napoli A, Zaccagna F, Di Paolo P, Saba L, Cavallo Marincola B, et al. 2012. [Article in English, Italian] Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients. Radiol Med. 117:54-71.

Borger MA. 2005. Preventing stroke during coronary bypass: are we focussing on the wrong culprit? J Cardiac Surg. 20:58-9.

Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. 2011. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of

Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 57:1002-44.

Çayır MÇ, Yüksel A. 2020. Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred? J Surg Med. 4(3):195- 198.

D’Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM. 1996. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg. 62:1714-23.

Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti L. 1994. Carotid plaque, aging, and riskfactors: A study of 457 subjects. Stroke. 25(6):1133-40.

Gökşin İ, Yağcı B, Baltalarlı A, Özcan V, Saçar M, Gürses E, et al. 2005. Routine Preoperative Carotid Doppler Ultrasonography in Patients Undergoing Coronary Artery Bypass Grafting. Türkiye Klinikleri J Med Sci. 25:221-6.

Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. 2003. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis—Society of Radiologists in Ultrasound consensus conference. Ultrasound Q. 19:190-8.

Gül K, Ustün I, Aydin Y, Berker D, Erol K, Unal M, et al. 2010. Carotid intima-media thickness and its relations with the complications in pati-ents with type 1 diabetes mellitus. Anatol J Cardiol. 10:52-58.

Hazar A, Altinbaş Ö, Aydın MS, Koçarslan A. 2020. Usefulness of Radial Artery as a Carotid Artery Patch in Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Graft Operation with Complete Arterial Revascularization. Heart Surg Forum. Oct 14;23(6):E752-E755.

Kawarada O, Yokoi Y, Morioka N, Nakata S, Higashiue S, Mori T, Iwahashi M, Hatada A. 2003. Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting. Circ J. Dec;67(12):1003-6.

Lahousse L, van den Bouwhuijsen QJ, Loth DW, Joos GF, Hofman A, Witteman JC, van der Lugt A, Brusselle GG, Stricker BH. 2013. Chronic obstructive pulmonary disease and lipid core carotid artery plaques in the elderly: the Rotterdam Study. Am J Respir Crit Care Med. Jan 1;187(1):58-64.

Lemne C, Jogestrand T, Faire deU. 1995. Carotid intima-media thickness and plaque in borderline hypertension. Stroke. 26(1):34-9.

Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. 2009. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 37:1-19.

Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. 2007. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and metaanalysis. Circulation. 115:459-67.

Mohammed MEA, Alshahrani S, Zaman G, Alelyani M, Hadadi I, Musa M. 2020. Lipid profile, random blood glucose and carotid arteries thickness in human male subjects with different ages and body mass indexes. Aging Male. Jun 8:1-7.

Naylor AR, Bown MJ. 2011. Stroke after cardiac surgery and its association with asymptomatic carotid disease: an updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 41:607-24.

Naylor AR, Mehta Z, Rothwell PM, Bell PRF. 2002. Carotif artery disease and stroke during coronery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg. 23(4):283-94.

Naylor AR, Ricco JB, Borst GJ de, Debus S, Haro J de, Halliday A, et al. 2018. Editor’s Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 55,3-81.

North American Symptomatic Carotid Endarterectomy Trial Collaborators. 1991. Beneficial effect of carotid endarterectomy in symptomatic patients high with grade stenosis. N Engl J Med. 325:445–53.

Pinho-Gomes AC, Taggart DP. 2017. Coronary artery bypass grafting for left main disease and the risk of stroke: Incidence, aetiology and prevention. Surgeon. Jun;15(3):155-160.

Rath PC, Agarwala MK, Dhar PK, Lakshmi C, Ahsan SA, Deb T, et al. 2001. Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery

bypass grafting. Indian Heart J. 53:761-5.

Snider F, Rossi M, Manni R, et al. 2000. Combined surgery for cardiac and carotid disease: Management and results of a rational approach. Eur J Vasc Endovasc Surg. 20:523-7.

Tyrrell DJ, Blin MG, Song J, Wood SC, Zhang M, Beard DA, Goldstein DR. 2020. Age-Associated Mitochondrial Dysfunction Accelerates Atherogenesis. Circ Res. Jan;31;126(3):298-314.

Ülger A, Şahin S, Bahadır FE, Uzunlulu N, Tuygun AK, Arslan Y, Bilgen F. 2011. Comparison of the incidences of carotid artery lesion and vertebrobasilary insufficiency with incidence of postoperative stroke in patients who undergo coronary artery bypass graft surgery. Turkish J Thorac Cardiovasc Surg. 19(2):127-137.

Velioglu Y, Isik M. 2019. Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary Artery Bypass Surgery. Thorac Cardiovasc Surg. Oct;67(7):546-553.

Weber F. 2002. Risk factors for subclinical carotid atherosclerosis in healthy men. Neurology. 59(4):524-28.



How to Cite

Işık, M., & Velioğlu, Y. (2021). Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups. The Heart Surgery Forum, 24(4), E724-E730.