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Is routine carotid screening for coronary surgery needed?

W A Walker1, W R Harvey, J R Gaschen

  • 1University of Tennessee, Memphis, Section of Cardiothoracic Surgery, USA.

The American Surgeon
|April 1, 1996
PubMed
Summary

Routine preoperative carotid duplex screening for all coronary surgery patients is not cost-effective. Selective screening based on patient history and physical exam is recommended to identify significant carotid artery disease.

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Area of Science:

  • Vascular Surgery
  • Cardiology
  • Diagnostic Imaging

Background:

  • Carotid artery disease and coronary artery disease often coexist.
  • Routine preoperative carotid duplex screening in coronary surgery patients is a common but potentially costly and time-consuming practice.

Purpose of the Study:

  • To evaluate the medical efficiency and cost-effectiveness of routine preoperative duplex carotid screening for all coronary surgery patients.
  • To determine if selective carotid screening based on patient history and physical examination is a more appropriate approach.

Main Methods:

  • Retrospective review of 308 coronary surgery patients, with duplex studies performed on 210.
  • Analysis of history and physical exam findings suggestive of carotid disease (e.g., TIA/RIND, CVA, AS-PVD, AAA, neck bruit, prior carotid surgery).

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  • Prospective study categorizing patients into "carotid" or "no-carotid" disease groups based on history and physical exam, followed by duplex scans.

    • Main Results:

    • In the retrospective review, 32% of patients with suggestive history/exam had positive scans, compared to 3% of those without.
    • In the prospective study, 27% of the "carotid disease" group had positive scans, while 0% of the "no-carotid disease" group did.

    Conclusions:

    • Preoperative carotid studies are recommended for coronary surgery patients with a history or physical exam suggestive of carotid disease (e.g., peripheral/cerebral vascular disease, neck bruit).
    • Routine, universal duplex carotid screening for all coronary surgery patients is not medically efficient or cost-effective.