The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery

Robert W. Barnes, Paul R. Liebman, Phyllis B. Marszalek, C. Louise Kirk, Mitchell Goldman

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

Prospective screening of 449 patients undergoing coronary or peripheral arterial revascularization detected asymptomatic cervical bruits in 44 patients (9.8%) and carotid obstruction by Doppler ultrasound in 63 individuals (14.0%). There was poor correlation between cervical bruit and carotid obstruction. No patient underwent prophylactic carotid endarterectomy. Three patients had transient ischemic attacks (TIAs), and five had nonfatal strokes perioperatively, only one of which was in the territory appropriate to carotid obstruction. Of 72 surviving patients with asymptomatic carotid disease, 10 (13.9%) had TIAs and one (1.4%) died of stroke during a 2-year follow-up, during which time only two (0.8%) of 254 patients without carotid disease reported symptoms of TIAs. Patients with asymptomatic carotid disease had a significantly higher incidence of perioperative and late deaths (10.6% and 9.2%, respectively), usually of myocardial infarction, as compared to patients without carotid disease (0.3% and 0.8%, respectively, P < 0.001). Asymptomatic carotid disease, although correlating poorly with perioperative stroke in patients undergoing cardiovascular operations, identifies patients at risk of late neurologic events and perioperative or late deaths from myocardial infarction. We do not recommend prophylactic carotid endarterectomy but favor operative intervention if patients develop TIAs during a period of careful follow-up.

Original languageEnglish (US)
Pages (from-to)1075-1083
Number of pages9
JournalSurgery
Volume90
Issue number6
StatePublished - Jan 1 1981
Externally publishedYes

Fingerprint

Asymptomatic Diseases
Transient Ischemic Attack
Carotid Endarterectomy
Stroke
Myocardial Infarction
Doppler Ultrasonography
Nervous System

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Barnes, R. W., Liebman, P. R., Marszalek, P. B., Kirk, C. L., & Goldman, M. (1981). The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery, 90(6), 1075-1083.

The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. / Barnes, Robert W.; Liebman, Paul R.; Marszalek, Phyllis B.; Kirk, C. Louise; Goldman, Mitchell.

In: Surgery, Vol. 90, No. 6, 01.01.1981, p. 1075-1083.

Research output: Contribution to journalArticle

Barnes, RW, Liebman, PR, Marszalek, PB, Kirk, CL & Goldman, M 1981, 'The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery', Surgery, vol. 90, no. 6, pp. 1075-1083.
Barnes RW, Liebman PR, Marszalek PB, Kirk CL, Goldman M. The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery. 1981 Jan 1;90(6):1075-1083.
Barnes, Robert W. ; Liebman, Paul R. ; Marszalek, Phyllis B. ; Kirk, C. Louise ; Goldman, Mitchell. / The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. In: Surgery. 1981 ; Vol. 90, No. 6. pp. 1075-1083.
@article{a11aebc6c6ce46d689ba158ffebf2105,
title = "The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery",
abstract = "Prospective screening of 449 patients undergoing coronary or peripheral arterial revascularization detected asymptomatic cervical bruits in 44 patients (9.8{\%}) and carotid obstruction by Doppler ultrasound in 63 individuals (14.0{\%}). There was poor correlation between cervical bruit and carotid obstruction. No patient underwent prophylactic carotid endarterectomy. Three patients had transient ischemic attacks (TIAs), and five had nonfatal strokes perioperatively, only one of which was in the territory appropriate to carotid obstruction. Of 72 surviving patients with asymptomatic carotid disease, 10 (13.9{\%}) had TIAs and one (1.4{\%}) died of stroke during a 2-year follow-up, during which time only two (0.8{\%}) of 254 patients without carotid disease reported symptoms of TIAs. Patients with asymptomatic carotid disease had a significantly higher incidence of perioperative and late deaths (10.6{\%} and 9.2{\%}, respectively), usually of myocardial infarction, as compared to patients without carotid disease (0.3{\%} and 0.8{\%}, respectively, P < 0.001). Asymptomatic carotid disease, although correlating poorly with perioperative stroke in patients undergoing cardiovascular operations, identifies patients at risk of late neurologic events and perioperative or late deaths from myocardial infarction. We do not recommend prophylactic carotid endarterectomy but favor operative intervention if patients develop TIAs during a period of careful follow-up.",
author = "Barnes, {Robert W.} and Liebman, {Paul R.} and Marszalek, {Phyllis B.} and Kirk, {C. Louise} and Mitchell Goldman",
year = "1981",
month = "1",
day = "1",
language = "English (US)",
volume = "90",
pages = "1075--1083",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery

AU - Barnes, Robert W.

AU - Liebman, Paul R.

AU - Marszalek, Phyllis B.

AU - Kirk, C. Louise

AU - Goldman, Mitchell

PY - 1981/1/1

Y1 - 1981/1/1

N2 - Prospective screening of 449 patients undergoing coronary or peripheral arterial revascularization detected asymptomatic cervical bruits in 44 patients (9.8%) and carotid obstruction by Doppler ultrasound in 63 individuals (14.0%). There was poor correlation between cervical bruit and carotid obstruction. No patient underwent prophylactic carotid endarterectomy. Three patients had transient ischemic attacks (TIAs), and five had nonfatal strokes perioperatively, only one of which was in the territory appropriate to carotid obstruction. Of 72 surviving patients with asymptomatic carotid disease, 10 (13.9%) had TIAs and one (1.4%) died of stroke during a 2-year follow-up, during which time only two (0.8%) of 254 patients without carotid disease reported symptoms of TIAs. Patients with asymptomatic carotid disease had a significantly higher incidence of perioperative and late deaths (10.6% and 9.2%, respectively), usually of myocardial infarction, as compared to patients without carotid disease (0.3% and 0.8%, respectively, P < 0.001). Asymptomatic carotid disease, although correlating poorly with perioperative stroke in patients undergoing cardiovascular operations, identifies patients at risk of late neurologic events and perioperative or late deaths from myocardial infarction. We do not recommend prophylactic carotid endarterectomy but favor operative intervention if patients develop TIAs during a period of careful follow-up.

AB - Prospective screening of 449 patients undergoing coronary or peripheral arterial revascularization detected asymptomatic cervical bruits in 44 patients (9.8%) and carotid obstruction by Doppler ultrasound in 63 individuals (14.0%). There was poor correlation between cervical bruit and carotid obstruction. No patient underwent prophylactic carotid endarterectomy. Three patients had transient ischemic attacks (TIAs), and five had nonfatal strokes perioperatively, only one of which was in the territory appropriate to carotid obstruction. Of 72 surviving patients with asymptomatic carotid disease, 10 (13.9%) had TIAs and one (1.4%) died of stroke during a 2-year follow-up, during which time only two (0.8%) of 254 patients without carotid disease reported symptoms of TIAs. Patients with asymptomatic carotid disease had a significantly higher incidence of perioperative and late deaths (10.6% and 9.2%, respectively), usually of myocardial infarction, as compared to patients without carotid disease (0.3% and 0.8%, respectively, P < 0.001). Asymptomatic carotid disease, although correlating poorly with perioperative stroke in patients undergoing cardiovascular operations, identifies patients at risk of late neurologic events and perioperative or late deaths from myocardial infarction. We do not recommend prophylactic carotid endarterectomy but favor operative intervention if patients develop TIAs during a period of careful follow-up.

UR - http://www.scopus.com/inward/record.url?scp=0019865245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0019865245&partnerID=8YFLogxK

M3 - Article

C2 - 7313942

AN - SCOPUS:0019865245

VL - 90

SP - 1075

EP - 1083

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 6

ER -