Is routine carotid screening for coronary surgery needed?
An association between carotid and coronary artery disease is well recognized. Routine preoperative duplex carotid screening of all coronary surgery patients is common, but may delay surgery and increase cost. To evaluate such a policy: A retrospective review of the records of 308 consecutive patients undergoing coronary surgery at one hospital was performed. Duplex studies were done on 210. A history of TIA/RIND, CVA, AS-PVD, AAA, neck bruit, or prior carotid surgery was considered suggestive for carotid disease. The history and/or physical exam (HPE) suggested carotid disease in 114; 37 of these (32%) had a positive scan. Of 96 patients without +HPE, three (3%) had a significant stenosis. A prospective study of cardiac surgery patients was done, categorized into "carotid" (n = 33) or "no-carotid" (n = 50) disease by two independent observers, based on +HPE. Positive scans were found in 27 per cent of the "carotid disease" group; No positive scans were found in the "no-carotid disease" group. We conclude that coronary surgery patients with peripheral or cerebral vascular disease or a neck bruit should have preoperative carotid studies. Duplex carotid screening of all cardiac patients is neither medically efficient nor cost-effective.
Walker
W A
WA
University of Tennessee, Memphis, Section of Cardiothoracic Surgery, USA.
Harvey
W R
WR
Gaschen
J R
JR
Appling
N A
NA
Pate
J W
JW
Weiman
D S
DS
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics