Clinical utility of carotid duplex ultrasound prior to cardiac surgery
Lin JC, Kabbani LS, Peterson EL, Masabni K, Morgan JA, Brooks S, Wertella KP, Paone G. Clinical utility of carotid duplex ultrasound prior to cardiac surgery. J Vasc Surg. 2016 Mar;63(3):710-4.
Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
OBJECTIVE: Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution.
METHODS: Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared.
RESULTS: Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (
CONCLUSIONS: In this study, the correlation between preoperative duplex-documented high-grade carotid stenosis and postoperative stroke was low. Prudent use of preoperative carotid duplex ultrasound should be based on the presence of cerebrovascular symptoms and the type of open heart surgery.
Medical Subject Headings
Aged; Carotid Arteries; Carotid Stenosis; Cerebrovascular Disorders; Coronary Artery Bypass; Databases, Factual; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Patient Selection; Predictive Value of Tests; Preoperative Care; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Tertiary Care Centers; Treatment Outcome; Ultrasonography, Doppler, Duplex