Increased incidence of proximal aortic atherosclerotic disease in patients with internal carotid occlusion.

Background: Atherosclerotic involvement of the proximal aorta is a major cause of embolic operative stroke in cardiac surgery. Its incidence is less well known in patients with severe carotid disease.
Methods: We reviewed the incidence of proximal atherosclerotic aortic disease in patients with internal carotid occlusion (group 1) and then compared it to a group of patients with normal carotids undergoing cardiac surgery (group 2). Both groups had preoperative carotid Doppler and epiaortic ultrasound analysis at the time of surgery.
Results: Epiaortic ultrasound results showed that the degree of atherosclerosis in group 1 was normal in 9 patients (10.2%), mild in 34 (38.6%), moderate in 29 (33%), and severe in 16 (18.2%). In group 2, the degree of atherosclerosis was normal in 70 patients (9.3%), mild in 466 (61.8%), moderate in 150 (19.9%), and severe in 68 (9.0%). Stroke rate was higher in group 1 at 4.5% versus 1.1% for group 2 (P =.029). No difference in surgical mortality was found.
Conclusions: Patients with internal carotid occlusions undergoing heart surgery have a higher incidence of proximal aortic atherosclerotic disease. Epiaortic ultrasound examination is strongly recommended.