Cardiac surgery in the presence of chronic internal carotid artery occlusion

  • Mario LescanEmail author
  • Volker Steger
  • Mateja Andic
  • Kujtim Veseli
  • Helene Haeberle
  • Tobias Krüger
  • Christian Schlensak
Original Article


The aim was to evaluate the incidence of stroke in the setting of cardiac surgery with or without hemodynamically relevant asymptomatic carotid stenosis contralateral to the occlusion. We designed a historical cohorts study, focused on patients with unilateral totally occluded internal carotid arteries who were referred for any cardiac surgery at our center. Isolated unilateral occlusions were assigned to group 1 (n = 60), and those with a contralateral stenosis grade ≥ 60% were included in group 2 (n = 51). A total of 111 patients operated in our center from 1997 to 2016 were included. Patients in group 2 had an asymptomatic contralateral internal carotid artery stenosis with a mean stenosis grade of 71 ± 20%. Simultaneous carotid endarterectomy (CEA) was performed in 22 patients from group 2. The overall mortality was 8/111 (7.2%). Carotid-associated mortality was not observed, whereas an overall stroke incidence of 8/111 (7.2%) was detected. The group-related outcome showed comparable results for mortality (group 1: 4/60 (6.7%) vs. group 2: 4/51 (7.8%); p = 1.0). Regarding stroke incidence, group 2 had a higher incidence of overall strokes (2/60 (3.3%) vs. 6/51 (11.8%); p = 0.14) with more contralateral (0/60 (0%) vs. 2/51 (3.9%); p = 0.209) and ipsilateral strokes (2/60 (3.3%) vs. 4/51 (7.8%); p = 0.411). Stroke rate peaked in patients with simultaneous carotid and cardiac surgery (n = 22; 18.2%; p = 0.048). Performing simultaneous CEA during cardiac surgery in the presence of a contralateral occlusion may promote stroke. Asymptomatic contralateral carotid stenosis is a risk factor for stroke in patients with carotid occlusion prior to cardiac surgery.


Endarterectomy Carotid Carotid stenosis Stroke Cardiac surgical procedures 


Compliance with ethical standards

Conflict of interest

The authors certify that they do not have any conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Mario Lescan
    • 1
    Email author
  • Volker Steger
    • 1
  • Mateja Andic
    • 1
  • Kujtim Veseli
    • 1
  • Helene Haeberle
    • 2
  • Tobias Krüger
    • 1
  • Christian Schlensak
    • 1
  1. 1.Department of Thoracic and Cardiovascular SurgeryUniversity Medical Center TübingenTübingenGermany
  2. 2.Department of AnesthesiologyUniversity Medical Center TübingenTübingenGermany

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