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Observational Study
. 2016 Feb;151(2):402-8.
doi: 10.1016/j.jtcvs.2015.09.108. Epub 2015 Oct 3.

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

Khalil Masabni  1 , Joseph F Sabik 3rd  2 , Sajjad Raza  1 , Theresa Carnes  3 , Hemantha Koduri  4 , Jay J Idrees  1 , Jocelyn Beach  5 , Haris Riaz  6 , Mehdi H Shishehbor  7 , Heather L Gornik  4 , Eugene H Blackstone  8
Affiliations
Observational Study

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

Khalil Masabni et al. J Thorac Cardiovasc Surg. 2016 Feb.

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.

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).

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).

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.

Keywords: carotid endarterectomy; carotid stenosis; coronary artery bypass grafting; ultrasound screening.

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Figures

FIGURE 1
FIGURE 1
Diagram of study flow showing carotid artery ultrasound screening, its results, interventions, and endpoints. pts., Patients; CABG, coronary artery bypass grafting; Pre-op, preoperative; CTA, computed tomography angiography; MRA, magnetic resonance angiography.
None
Stroke occurrence by severity of carotid artery stenosis in patients undergoing coronary artery bypass grafting.
See this image and copyright information in PMC

Comment in

  • Discussion.
    MacGillivray TE, Sundt T, Almassi GH, Pomar JL. MacGillivray TE, et al. J Thorac Cardiovasc Surg. 2016 Feb;151(2):408-9. doi: 10.1016/j.jtcvs.2015.09.114. Epub 2015 Nov 14. J Thorac Cardiovasc Surg. 2016. PMID: 26586356 No abstract available.
  • Preoperative carotid ultrasound through the looking glass: Curiouser and curiouser!
    Kurlansky P. Kurlansky P. J Thorac Cardiovasc Surg. 2016 Feb;151(2):410-1. doi: 10.1016/j.jtcvs.2015.10.079. Epub 2015 Oct 28. J Thorac Cardiovasc Surg. 2016. PMID: 26589537 No abstract available.

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