Carotid Ultrasound Assessment prior to Coronary Artery Bypass Grafting – an Irish Cardiac Surgery Centre’s Experience

Abstract

IntroductionCarotid stenosis is a risk factor for cerebrovascular accident(CVA) following coronary artery bypass grafting(CABG). Guidelines recommend selective pre-operative screening with Doppler US but non-selective application is commonplace. Recent data has questioned the efficacy of peri-operative carotid intervention, challenging the value of this practice. AimTo analyse the utility of carotid US assessment prior to CABG in our institution. MethodsThis was a retrospective review of all patients over 18 that underwent a non-emergency CABG in a single Irish cardiac surgery centre from January 2019 to December 2022. Results1161 subjects were included. 1084/1161(93.36%) underwent US assessment. 41/1084(3.8%) had ≥70% stenosis and 189/1084(17.5%) had ≥50% stenosis. 32/1084(2.95%) underwent confirmatory imaging and 7/1084(0.64%) underwent carotid intervention. Post-operative CVA occurred in 18/1161(1.55%) and ≥70%(p=0.024) and ≥50%(p<0.001) carotid stenosis were associated with same.Chronic kidney disease (OR=1.66,p=0.01), decreasing haemoglobin (OR=1.13,p=0.019), increasing age (OR=1.03,p=0.011) and being a current (OR=3.21,p<0.001) or ex- smoker (OR=1.82,p=0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease was not associated with carotid stenosis (p=0.563).Of those that underwent carotid intervention, 0/7(0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70%(p=1) or ≥50%(p=1) carotid stenosis. ConclusionCarotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel coronary artery disease was not associated with carotid stenosis despite European guidelines listing it as a screening criteria. Predictive models must be developed using identified risk factors to enable targeted pre-operative screening.