Two studies suggest that limiting DUS to patients with at least one risk factor (age >70 years, history of cerebrovascular disease, presence of a carotid bruit, multivessel CAD or LEAD) identifies all patients with carotid stenosis >70%, reducing the total number of scans by 40%.338,358 However, a study comparing patients undergoing a preoperative carotid scan before cardiac surgery with those without screening reported no difference in perioperative mortality and stroke.345 But only 12% of those with severe carotid stenosis underwent synchronous CABG plus CEA. Hence routine carotid DUS identifies only the minority of patients who will develop perioperative stoke, without clearly evidenced benefit of prophylactic carotid revascularization. Carotid DUS is indicated in patients with recent (<6 months) stroke/TIA. No carotid imaging is indicated when CABG is urgent, unless neurological symptoms occurred in the previous 6 months.
Recommendations on screening for carotid disease in patients undergoing coronary artery bypass grafting
 |
|
