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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 (TIA or stroke), hypertension, smoking or diabetes.
Identify the incidence of carotid artery disease and outcomes of cardiac surgery. Endpoints include mortality, cerebrovascular accident, and prevalence of significant carotid stenosis (80-99%) and prevalence of carotid endarterectomy.
A retrospective analysis of LAC+USC Medical Center and Keck Medical Center coronary artery bypass patients from January 2012 to December 2013 was performed.
We identified 340 patients (78% female, 22% male); average age was 61 years. The majority of the patients underwent pre-operative carotid screening with ultrasound (93%). Significant carotid artery stenosis (80-99%) was found in 41 arteries, which accounted for 12% of patients. Of the patients with significant carotid artery stenosis 8 (2.35%) underwent carotid endarterectomy (two of the patients underwent endarterectomy post-bypass). There were 3 post-operative cerebrovascular events (0.88%). Overall mortality was 1.18%.
The incidence of significant carotid stenosis is low and even lower for those requiring pre-operative intervention of the carotid stenosis. The overall mortality and incidence of cerebrovascular events are also low. Of the three patients with post-operative cerebrovascular events, none had significant carotid stenosis. Further research will investigate risk factors to identify a higher risk population that may derive benefit from pre-operative screening.