Related Experiment Videos
Mandatory versus selective preoperative carotid screening: a retrospective analysis
Daniel J Durand1, Bruce A Perler, Glen S Roseborough
1Department of Surgery, Division of Cardiac Surgery, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
The Annals of Thoracic Surgery
|June 30, 2004
Summary
Selective carotid screening for coronary artery bypass (CAB) surgery patients can reduce screening burden. Focusing on high-risk individuals, like those over 65 or with cerebrovascular disease, is effective.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Extracranial internal carotid artery stenosis is a known risk factor for stroke during coronary artery bypass (CAB) surgery.
- The efficacy of selective versus nonselective preoperative carotid screening in CAB patients remains unclear.
Purpose of the Study:
- To evaluate the clinical efficacy of selective preoperative carotid screening in CAB patients.
- To identify risk factors for significant carotid stenosis and assess its impact on perioperative outcomes.
Main Methods:
- Retrospective review of 1421 consecutive CAB patients (2000-2002).
- Univariate and multivariate analyses to identify risk factors for carotid stenosis (>= 70%).
- Stratification into high- and low-risk groups based on stenosis and stroke risk factors.
Main Results:
- Significant carotid stenosis prevalence was 13.4% among screened patients (80.1% of total).
- Risk factors for stenosis included age >65, peripheral vascular disease, prior cerebrovascular accident, carotid bruit, and hypertension.
- High-risk patients had higher stenosis prevalence (17.8%) and stroke rates (9/708) compared to low-risk patients (6.1%, 0/426).
Conclusions:
- Selective screening of patients aged >65, with carotid bruit, or cerebrovascular disease could reduce screening by ~40%.
- This selective approach showed negligible impact on surgical management or neurologic outcomes.