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A predictive model for screening cerebrovascular disease in patient undergoing coronary artery bypass grafting
Victor Aboyans1, Philippe Lacroix, Jérôme Guilloux
1Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France. aboyans@unilim.fr
Insights
Identifying stroke risk factors in coronary artery bypass grafting (CABG) patients can optimize carotid artery screening. This approach efficiently detects significant carotid lesions, improving patient outcomes and reducing unnecessary duplex scans.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Stroke is a serious complication of Coronary Artery Bypass Grafting (CABG).
- Coexisting carotid artery disease is a significant, potentially avoidable cause of perioperative stroke.
- Systematic carotid screening for all CABG candidates is inefficient.
Purpose of the Study:
- To optimize Duplex ultrasound screening for carotid artery disease in CABG candidates.
- To identify risk factors associated with significant carotid lesions in this population.
Main Methods:
- A prospective study of 1043 consecutive CABG candidates using Duplex scanning.
- A predictive model for >50% carotid stenosis was developed using data from 825 patients.
- The model's predictive ability was validated on a separate group of 218 patients.
Main Results:
- 13.1% and 7% of patients had >50% and >70% carotid stenosis, respectively.
- Independent predictors of significant stenosis included: prior stroke/TIA, neck bruit, peripheral arterial disease (PAD), and age >70.
- The identified risk factors detected 92.3% of >50% stenosis and 100% of >70% stenosis, potentially excluding 41% from routine screening.
Conclusions:
- A targeted risk assessment approach is highly sensitive for detecting cerebrovascular disease in CABG candidates.
- This strategy enables efficient screening, improving patient selection for further investigation and reducing healthcare costs.
Objective:
The occurrence of stroke during coronary artery bypass grafting (CABG) is multifactorial but the coexistence of carotid disease is considered as one of the avoidable sources. Beyond the perioperative management, the detection of carotid disease in a coronary patient could be of prognostic significance. A systematic screening for all candidates for CABG could, however, be a non-efficient strategy. We aimed to optimize the Duplex screening of candidates for CABG by studying risk factors of significant concomitant carotid lesions.
Methods:
We prospectively studied 1043 consecutive candidates for CABG by Duplex scanning. A first subgroup of 825 patients permitted to establish the predictive model of >50% stenosis. A multivariate analysis provided independent predictive factors. The ability of the model to predict >50% and >70% stenosis of neck arteries has been prospectively assessed on the 218 consecutive patients.
Results:
In the first group, 108 (13.1%) and 58 (7%) had respectively at least a >50% and >70% stenosis. The independent risk factors were: past history of stroke or transient ischemic attack, neck bruit, clinically apparent peripheral arterial disease (PAD) or subclinical PAD (ABI <0.85 or >1.5), and age >70 years (P<0.05). Among the subsequent 218 patients, the presence of at least one of these factors was able to detect 24 out of 26 patients (92.3%) with a >50% stenosis, and 100% of those with >70% stenosis, and could rule out 41% from a systematic Duplex screening.
Conclusions:
The excellent sensitivity of this risk assessment approach, makes an efficient screening of cerebrovascular disease possible in CABG patients.
