title: Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  A total of 1069 (86%) had <moderate; 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 with <moderate 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Khalil
authors.initials: K
authors.lastname: Masabni
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio. Electronic address: sabikj@ccf.org.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Raza
authors.affiliation: Department of Quantitative Health Sciences, Research Institute, Cleveland, Ohio.
authors.forename: Theresa
authors.initials: T
authors.lastname: Carnes
authors.affiliation: Department of Vascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Hemantha
authors.initials: H
authors.lastname: Koduri
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Idrees
authors.affiliation: Department of Vascular Surgery, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Beach
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Haris
authors.initials: H
authors.lastname: Riaz
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
authors.affiliation: Department of Vascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000592:standards; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: carotid endarterectomy; carotid stenosis; coronary artery bypass grafting; ultrasound screening