Preoperative Carotid Duplex Scanning in Patients Undergoing Coronary Artery Bypass Grafting

Kara, Hakan

doi:10.21470/1678-9741-2019-0131

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…A study by Kara on the risk of carotid artery stenosis in patients undergoing CABG found that of the eight patients with mean age 48 years diagnosed with ≥70% stenosis, 50% were < 70 years old. If the study had chosen to perform selective carotid DUS only in patients aged ≥70 years, four patients would not have been detected [25]. In our study, 16 patients in the low-risk group were diagnosed with ≥70% stenosis.…”

Section: Discussionmentioning

confidence: 79%

Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Ali

Shokri

Jawad

2020

J Cardiothorac Surg

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Background Atherosclerosis is a systemic disease affecting the coronary, carotid, and lower limb arteries. Cerebrovascular accidents and lower limb ischemia are devastating postoperative complications. We aimed to evaluate the role of non-selective routine arterial duplex scanning in patients undergoing coronary artery bypass grafting (CABG). Methods This non-randomized clinical trial included 360 patients scheduled for elective isolated CABG who were divided into two groups: low-risk (n = 180) and high-risk (n = 180). Both groups underwent preoperative carotid and lower limb ultrasound screening for associated arteriopathy. Results 16 (8.9%) patients and 22 (12.2%) patients showed ≥70% carotid artery stenosis while 11 patients (6.1%) and 20 patients (11.1%) showed ≥50% lower limb arterial stenosis in the low-risk group and the high-risk group, respectively; though the difference was not statistically significant in both the cases (p > 0.1). Conclusion Routine preoperative peripheral arterial screening by sonography is a feasible and effective strategy to avoid unnecessary post CABG complications. Trial registration NCT03516929, Registered in 24 th of April 2018.

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Section: Discussionmentioning

confidence: 79%

Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Ali

Shokri

Jawad

2020

J Cardiothorac Surg

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“…Atherosclerosis is a systematic inflammatory disease and, therefore, a strong relation between coronary atherosclerosis and carotid artery stenosis (CAS) has commonly been assumed [ 6 - 7 ]. Moreover, there is evidence to suggest that significant CAS is common among patients undergoing cardiac surgery with a high risk of critical neurological events [ 8 - 9 ]. Approximately 30% of annual global mortality is attributable to cardiovascular disease, while an additional 10% is attributable to cerebrovascular events [ 10 - 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Carotid Artery Stenosis (CAS) Among Cardiac Surgery Patients

Alsalmi¹,

Abdeen²

2023

Cureus

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Introduction: Cardiac disease and carotid atherosclerosis rates have increased in recent years. Carotid artery stenosis (CAS) has been recognized as a high-risk factor of perioperative stroke among cardiac surgery patients.Aims: The aims of the study are to identify the prevalence and common risk factors of CAS among patients undergoing cardiac surgery that include coronary artery bypass surgery or valvular cardiac surgery.Materials and Methods: This retrospective cross-sectional study was conducted in the radiology department at Medina Cardiac Center, Al Madinah Al-Munawara. The inclusion criteria for the study were patients aged ≥ 20 years who were scheduled for coronary artery bypass surgery or valvular cardiac surgery and had carotid duplex examination before surgery. A Philips X matrix IU22 linear-array ultrasound probe (Philips, Bothell, WA) was used to scan the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery.Results: Of the 261 patients in this study, 78.5% ( n = 205) were male. The mean age of patients was 61.6 ± 11.3 years (median: 62.0; range: 55.5-68.0). The overall prevalence of CAS was 71% (n = 187): 52% (n = 136) with bilateral CAS and 19.5% (n = 51) with unilateral CAS. Age group was significantly associated with bilateral CAS and the severity of CAS (p = 0.001). Diabetes mellitus, hypertension and both diabetes mellitus and hypertension together were significantly associated with CAS status (p < 0.05, for all). A significantly higher proportion of smokers had a mild level of CAS on the left side compared to non-smokers (55.8% vs. 46.5%, p = 0.033). Gender and weight status were not linked to severity of CAS. Conclusion:This study shows a high prevalence of CAS among cardiac surgery patients. In addition, older age, diabetes mellitus, and hypertension were found to be major risk factors for CAS. Gender and weight status were not associated with CAS. Preoperative carotid duplex scan is a useful exam to identify CAS among cardiac surgery patients and, therefore, to predict and reduce postoperative neurological complications.

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“…Due to the systemic nature of atherosclerosis, patients with severe CAD requiring CABG frequently exhibit severe carotid artery stenosis as well. 1,2 One of the most devastating complications following CABG is stroke and its frequency is estimated to 1-5%. [3][4][5][6] Cerebral hypoperfusion due to severe carotid disease is one of the risk factors for stroke during or shortly after CABG.…”

Section: Introductionmentioning

confidence: 99%

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Tzoumas

Giannopoulos²,

Charisis

et al. 2020

Vascular

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Background Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. Objective The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. Methods This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. Results Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00–13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88–23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18– 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02–3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04– 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03–4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02–3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50–27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01–12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84–15.20; I2 = 0.0%) after a mean follow-up of 47 months. Conclusion The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.

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Preoperative Carotid Duplex Scanning in Patients Undergoing Coronary Artery Bypass Grafting

Cited by 4 publications

References 27 publications

Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Prevalence and Risk Factors of Carotid Artery Stenosis (CAS) Among Cardiac Surgery Patients

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

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