Back to Search Start Over

Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?

Authors :
Masabni K
Sabik JF 3rd
Raza S
Carnes T
Koduri H
Idrees JJ
Beach J
Riaz H
Shishehbor MH
Gornik HL
Blackstone EH
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.)

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