title: Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?
abstract: BACKGROUND
  Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant.
  
  
  OBJECTIVE
  To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease.
  
  
  METHODS
  The case records of patients consecutively undergoing CAB were reviewed. Patients were stratified retrospectively into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke: peripheral vascular disease (PVD), carotid bruit, diabetes mellitus, age >70 years and/or history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management and perioperative stroke rates were determined in each group.
  
  
  RESULTS
  Overall, 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis was 5.8%. Univariate analysis confirmed that PVD (P=0.005), carotid bruit (P=0.003) and diabetes mellitus (P=0.05) were significant risk factors for stenosis. Carotid stenosis was a risk factor for stroke (P=0.03). Prevalence of carotid stenosis was higher in the high-risk group (9.1%) than the low-risk group (1.2%) (P<0.05). All concomitant or staged carotid endarterectomies/CAB (5/205) and all patients who had perioperative strokes (5/205) were in the high-risk group (P=0.01).
  
  
  CONCLUSIONS
  In our cohort, selective screening of patients aged >70 years, with carotid bruit, a history of cerebrovascular disease, diabetes mellitus or PVD would have reduced the screening load by 40%, with trivial impact on surgical management or neurological outcomes.
authors.affiliation: Department of Cardiology, La-Cavale-Blanche Hospital, Brest University Hospital, Boulevard T.-Prigent, 29609 Brest Cedex, France. jean-christophe.cornily@chu-brest.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Cornily
authors.forename: David
authors.initials: D
authors.lastname: Le Saux
authors.forename: Ulric
authors.initials: U
authors.lastname: Vinsonneau
authors.forename: Eric
authors.initials: E
authors.lastname: Bezon
authors.forename: Florent
authors.initials: F
authors.lastname: Le Ven
authors.forename: Gregoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Luc
authors.initials: L
authors.lastname: Bressollette
authors.forename: Jacques
authors.initials: J
authors.lastname: Mansourati
authors.forename: Jacques
authors.initials: J
authors.lastname: Boschat
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Blanc
mesh_terms: D000368:Aged; D000465:Algorithms; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D018616:Ultrasonography, Doppler, Duplex