Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?
| Autor: | Haris Riaz, Theresa Carnes, Mehdi H. Shishehbor, Sajjad Raza, Khalil Masabni, Joseph F. Sabik, Hemantha Koduri, Heather L. Gornik, Jocelyn M. Beach, Eugene H. Blackstone, Jay J. Idrees |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Time Factors Bypass grafting medicine.medical_treatment Coronary Artery Bypass Off-Pump Coronary Artery Disease Carotid endarterectomy 030204 cardiovascular system & hematology Severity of Illness Index Coronary artery disease 0302 clinical medicine Risk Factors Carotid Stenosis Prospective Studies Registries Coronary Artery Bypass Prospective cohort study Stroke Ultrasonography Endarterectomy Carotid Middle Aged Quality Improvement Carotid Arteries Treatment Outcome surgical procedures operative medicine.anatomical_structure Predictive value of tests Cardiology Female Cardiology and Cardiovascular Medicine Artery Pulmonary and Respiratory Medicine medicine.medical_specialty Article 03 medical and health sciences Predictive Value of Tests Internal medicine Severity of illness medicine Humans cardiovascular diseases Aged Quality Indicators Health Care business.industry medicine.disease Surgery business 030217 neurology & neurosurgery |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 151:402-409 |
| ISSN: | 0022-5223 |
| Popis: | To determine whether nonselective preoperative carotid artery ultrasound screening alters management of patients scheduled for coronary artery bypass grafting (CABG), and whether such screening affects neurologic outcomes.From March 2011 to September 2013, preoperative carotid artery ultrasound screening was performed on 1236 of 1382 patients (89%) scheduled to undergo CABG. Carotid artery stenosis (CAS) was classified as none or mild (any type 0%-59% stenosis), moderate (unilateral 60%-79% stenosis), or severe (bilateral 60%-79% stenosis or unilateral 80%-100% stenosis).A total of 1069 (86%) hadmoderate; 90 (7.3%) had moderate; and 77 (6.2%) had severe CAS. Of those with moderate CAS, 4 (4.4%) had preoperative confirmatory testing, and 1 (1.1%) underwent combined CABG + carotid endarterectomy (CEA); 11 (12%) had off-pump surgery. Of those with severe CAS, 18 (23%) had confirmatory testing, and 18 (23%) underwent combined CABG + CEA; 6 (7.8%) had off-pump surgery. Stroke occurred in 14 of 1069 (1.3%) patients withmoderate CAS; 2 of 90 (2.2%) of those with moderate CAS; and 2 of 77 (2.6%) of those with severe CAS (P = .3). In patients with ≥moderate CAS, 1 of 19 (5.3%) undergoing CABG + CEA and 3 of 148 (2.0%) undergoing CABG alone experienced stroke (P = .4). In patients with moderate CAS, stroke occurred in 1 of 11 (9.1%) off-pump and 1 of 79 (1.3%) on-pump patients (P = .2). In patients with severe CAS, stroke occurred in 1 of 6 (17%) off-pump and 1 of 71 (1.4%) on-pump patients (P = .15).Routine preoperative carotid artery evaluation altered the management of a minority of patients undergoing CABG; this did not translate into perioperative stroke risk. Hence, a more targeted approach for preoperative carotid artery evaluation should be adopted. |
| Databáze: | OpenAIRE |
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