Introduction
In the past decade, there has been an increase in the amount of patients with medical co-morbidities referred for coronary artery bypass surgery (CABG). Cerebrovascular accident (CVA) after CABG is a devastating and multi-factorial problem. Carotid artery disease in patients undergoing cardiopulmonary bypass procedures may increase the risk of significant neurological complication. We review the results of carotid screening, management and outcome of carotid disease in patients referred for CABG.
Methods
Between 2008 through 2010, 673 patients were referred for isolated coronary artery bypass surgery at a single institution. Patients were identified through a systematic review of The Department of Cardiothoracic Surgery Society of Thoracic Surgery Outcomes Database. A retrospective analysis of prospectively collected demographic, clinical data and outcomes were preformed. All patients with screening preoperative carotid duplex were reviewed. We defined the degree of carotid disease as: none to mild stenosis (<50%), moderate stenosis (50-69%), severe stenosis (70-99%).
Results
559 (83%) patients underwent screening preoperative carotid ultrasonography prior to surgery. Patient demographics and clinical variable are listed in
Table 1
. Severity of carotid disease on preoperative imaging was none/mild (68%), unilateral moderate disease (17%), bilateral moderate (7%) and severe (8%). 12 (2.1 %) of patients underwent a preoperative carotid endarterectomy and subsequent CABG, with no peri-operative cardiac events or CVAs. Only 4 (0.7%) patients in the entire series had a peri-operative CVA.
Conclusions
Routine use of carotid ultrasound in patients referred for CABG with aggressive management may reduce the incidence of peri-operative CVA.
