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Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2016 Feb; Vol. 151 (2), pp. 402-8. Date of Electronic Publication: 2015 Oct 03. - Publication Year :
- 2016
-
Abstract
- Objectives: To determine whether nonselective preoperative carotid artery ultrasound screening alters management of patients scheduled for coronary artery bypass grafting (CABG), and whether such screening affects neurologic outcomes.<br />Methods: From March 2011 to September 2013, preoperative carotid artery ultrasound screening was performed on 1236 of 1382 patients (89%) scheduled to undergo CABG. Carotid artery stenosis (CAS) was classified as none or mild (any type 0%-59% stenosis), moderate (unilateral 60%-79% stenosis), or severe (bilateral 60%-79% stenosis or unilateral 80%-100% stenosis).<br />Results: A total of 1069 (86%) had <moderate; 90 (7.3%) had moderate; and 77 (6.2%) had severe CAS. Of those with moderate CAS, 4 (4.4%) had preoperative confirmatory testing, and 1 (1.1%) underwent combined CABG + carotid endarterectomy (CEA); 11 (12%) had off-pump surgery. Of those with severe CAS, 18 (23%) had confirmatory testing, and 18 (23%) underwent combined CABG + CEA; 6 (7.8%) had off-pump surgery. Stroke occurred in 14 of 1069 (1.3%) patients with <moderate CAS; 2 of 90 (2.2%) of those with moderate CAS; and 2 of 77 (2.6%) of those with severe CAS (P = .3). In patients with ≥moderate CAS, 1 of 19 (5.3%) undergoing CABG + CEA and 3 of 148 (2.0%) undergoing CABG alone experienced stroke (P = .4). In patients with moderate CAS, stroke occurred in 1 of 11 (9.1%) off-pump and 1 of 79 (1.3%) on-pump patients (P = .2). In patients with severe CAS, stroke occurred in 1 of 6 (17%) off-pump and 1 of 71 (1.4%) on-pump patients (P = .15).<br />Conclusions: Routine preoperative carotid artery evaluation altered the management of a minority of patients undergoing CABG; this did not translate into perioperative stroke risk. Hence, a more targeted approach for preoperative carotid artery evaluation should be adopted.<br /> (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Carotid Stenosis complications
Carotid Stenosis surgery
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease complications
Coronary Artery Disease diagnosis
Endarterectomy, Carotid
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Quality Improvement
Quality Indicators, Health Care
Registries
Risk Factors
Severity of Illness Index
Stroke etiology
Time Factors
Treatment Outcome
Ultrasonography
Carotid Arteries diagnostic imaging
Carotid Stenosis diagnostic imaging
Coronary Artery Bypass adverse effects
Coronary Artery Bypass standards
Coronary Artery Disease surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 151
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26586360
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2015.09.108