Screening carotid ultrasound in asymptomatic patients prior to cardiac surgery: is it justified?
Tóm tắt
Background
Screening carotid duplex ultrasound (DUS) in asymptomatic patients prior to cardiac surgery is often performed on a selective basis for patients at high risk of carotid disease as a means to potentially reduce the risk of neurological complications. However there is conflicting evidence of the actual benefits of this approach in altering the approach to management and in reducing neurological events.
Methods
A retrospective analysis of screening carotid DUS performed in patients prior to cardiac surgery was undertaken in a vascular ultrasound laboratory servicing a tertiary hospital. Adult patients undergoing coronary procedures were included. The criteria for screening preoperative carotid DUS included left main disease, peripheral vascular disease, previous stroke/TIA, previous carotid intervention and aortic arch calcification.
Results
From 2011 to 2018 265 patients met the criteria for carotid DUS screening prior to. 54 patients (20.4%) had a hemodynamically significant carotid stenosis (50-99%). There were no staged or synchronous carotid interventions. PVD and more than two high risk criteria present were most strongly associated with carotid disease. There were a total of nine postoperative strokes/TIA and there was no significant association between the presence of carotid stenosis and postoperative stroke or TIA, X(1)=0.001, p=0.980. Stroke occurred in two patients with carotid stenosis, but both were outside of the brain territory associated with the carotid disease.
Conclusion
In a highly selective group of asymptomatic patients prior to cardiac surgery, screening carotid DUS identified the presence of significant carotid stenosis in 20% of patients. The presence of any carotid stenosis was not associated with periprocedural stroke/TIA. Screening for asymptomatic carotid stenosis prior to cardiac surgery demonstrated no benefit in this population thus further adding to the evidence that the clinical utility of this common practice is questionable.
