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Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?

Abstract : BACKGROUND: Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant. AIM: To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease. METHODS: The case records of patients consecutively undergoing CAB were reviewed. Patients were stratified retrospectively into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke: peripheral vascular disease (PVD), carotid bruit, diabetes mellitus, age >70 years and/or history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management and perioperative stroke rates were determined in each group. RESULTS: Overall, 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis was 5.8%. Univariate analysis confirmed that PVD (P=0.005), carotid bruit (P=0.003) and diabetes mellitus (P=0.05) were significant risk factors for stenosis. Carotid stenosis was a risk factor for stroke (P=0.03). Prevalence of carotid stenosis was higher in the high-risk group (9.1%) than the low-risk group (1.2%) (P<0.05). All concomitant or staged carotid endarterectomies/CAB (5/205) and all patients who had perioperative strokes (5/205) were in the high-risk group (P=0.01). CONCLUSION: In our cohort, selective screening of patients aged >70 years, with carotid bruit, a history of cerebrovascular disease, diabetes mellitus or PVD would have reduced the screening load by 40%, with trivial impact on surgical management or neurological outcomes.
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https://hal.univ-brest.fr/hal-00721510
Contributor : Ghislaine Calvez <>
Submitted on : Friday, July 27, 2012 - 4:22:51 PM
Last modification on : Thursday, November 29, 2018 - 4:09:28 PM

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Jean-Christophe Cornily, David Le Saux, Ulric Vinsonneau, Eric Bezon, Florent Le Ven, et al.. Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?. Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2011, 104 (2), pp.77-83. ⟨10.1016/j.acvd.2010.11.008⟩. ⟨hal-00721510⟩

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