Author + information
- Lucas Christianson,
- Merije Chukumerije,
- Anilkumar Mehra,
- David Shavelle,
- Leonardo Clavijo,
- Ray Matthews and
- Miyako Igari
Guidelines recommend that high-risk patients be screened for carotid artery disease prior to cardiac surgery. High-risk patients are defined as those with age >65 years, left main disease, peripheral arterial disease, history of cerebrovascular disease, hypertension, smoking or diabetes.
Identify the incidence of carotid artery disease and outcomes of cardiac surgery. Endpoints include in-hospital mortality and cerebrovascular events.
A retrospective analysis of LAC+USC Medical Center and Keck Medical Center coronary artery bypass patients from January 2008 to December 2013 was performed.
We identified 793 patients (77% male, 23% female); average age was 60 years. The majority of the patients underwent pre-operative carotid screening with ultrasound (86%). Significant carotid artery stenosis (≥80%) was found in 55 patients (6.9%). Patients with significant carotid stenosis were more likely to be older (67.8±8.9 years vs. 59.7±8.8 years, p<0.0001), more likely to have peripheral arterial disease (7 (12.7%) vs. 32 (5.1%), p 0.02) and more likely have a history of a prior cerebral vascular events (9 (16.4%) vs. 44 (7.0%), p 0.01). Eighteen patients (2.3%) underwent carotid endarterectomy (CEA). Twelve CEA were combined procedures with coronary artery bypass surgery, two were done post-bypass and four were done pre-bypass. Two of the 18 CEA were done for symptomatic carotid stenosis the remaining patients were asymptomatic. There were no significant differences in cerebral vascular events between those with significant stenosis and those without. There were 12 post-operative cerebrovascular events (1.5%) of these only two were in patients with significant carotid stenosis. Overall in-hospital mortality was 1.6%. There was a significant difference in mortality between those with significant carotid stenosis and those without (4 (7.3%) vs. 5 (0.8%), p 0.004).
The incidence of significant carotid stenosis is low and even lower for those requiring perioperative intervention. Severe carotid stenosis does not predict post-operative cerebrovascular events. Mortality was significantly higher among those with significant carotid disease. This increase in mortality is not due to an increased rate of cerebrovascular events. Given the low rate of significant carotid stenosis and lack of ability to predict cerebral vascular events routine pre-operative screening for carotid stenosis is not of benefit.