066 Assessment of carotid artery stenosis before coronary artery bypass surgery

Abstract

Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass (CAB) surgery. Although both selective and nonselective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant. Files of patients consecutively undergoing CAB were reviewed. Patients were retrospectively stratified into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke identified in the literature: presence of peripheral vascular disease, carotid bruit, diabetes mellitus, age over 70 years and/or previous history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management, and perioperative stroke rates were determined in each group. 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis detected by ultrasonography was 5.8%. Univariate analysis confirmed that peripheral vascular disease (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 high-risk group than in low-risk group (9.1% vs 1.2%; p<0.05). All concomitant or staged carotid endarterectomies/CAB (5/205) and all patients who suffered perioperative strokes (5/205) were in the high-risk group (p = 0.01). In our cohort, selective screening of patients with either an age over 70, a carotid bruit, a history of cerebrovascular disease, a diabete mellitus or a peripheral vascular disease would have reduced the screening load by 40% with trivial impact on surgical management or neurologic outcomes.