Carotid and aortic screening for coronary artery bypass grafting

Fukuda, Ikuo; Gomi, Seigo; Watanabe, Ko; Seita, Jun

doi:10.1016/s0003-4975(00)02132-9

Cited by 77 publications

(43 citation statements)

References 20 publications

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“…The prevalence of carotid stenosis ≥ 50% in patients undergoing cardiac surgery (CABG; CABG + valve surgery) ranges from 3.8% to 22%. [15][16][17][18][19][20] The presence of significant (≥ 70%) internal carotid artery stenosis in our Correlates of carotid stenosis in CABG patients 235 study was 7.7%. Selectively screening patients with carotid artery DUS, as opposed to screening every patient > 65 years old, would provide a more streamlined and cost-effective approach to carotid DUS prior to CABG.…”

Section: Discussionmentioning

confidence: 78%

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

et al. 2009

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Carotid duplex ultrasonography (DUS) is routinely performed prior to coronary artery bypass graft surgery (CABG) on all patients > 65 years old because of the reported associated risk of finding concomitant carotid artery stenosis. Identifying risk factors that correlate with severe carotid stenosis may result in more costeffective screening for patients with asymptomatic carotid artery disease prior to CABG. We performed a retrospective study to identify risk factors for significant carotid artery disease in patients scheduled to undergo CABG between March 2005 and March 2008 at the Massachusetts General Hospital. Patients with carotid stenosis ≥ 70% identified by DUS (n = 50) were matched by age and sex to control patients who had < 50% stenosis (n = 50). Data were analyzed using the chi-squared test or analysis of variance as appropriate. Logistic regression was used to examine multivariate correlates of carotid stenosis. A total of 643 patients were screened to arrive at the patient cohorts described below. This produced a prevalence of 7.7% for significant (> 70%) carotid disease. The patient cohorts were predominantly male with no significant difference in the incidence of diabetes, hypertension, extent of coronary artery disease (CAD) (i.e. left main coronary artery disease (LMCA) and one, two-, or three-vessel CAD) or lipid abnormalities in the two groups. Univariate analysis identified the presence of peripheral arterial disease (PAD, p = 0.001), a cervical bruit (p < 0.0001), a prior neurological event (p = 0.020), and the presence of an abdominal aortic aneurysm (AAA; p = 0.046) as significant predictors of ≥ 70% internal carotid artery stenosis. Logistic regression analysis revealed that the presence of a carotid bruit (p = 0.0068) and PAD (p = 0.0194) were associated with an increased risk of significant carotid artery disease. In conclusion, the presence of a carotid bruit or PAD predicts an increased likelihood of significant carotid artery disease in patients undergoing CABG. Unlike previous studies, LMCA or extent of CAD did not correlate with significant carotid artery disease. Using these predictive models, a prospective outcomes trial is required to validate these criteria.

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Section: Discussionmentioning

confidence: 78%

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

et al. 2009

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“…20 Likewise, significant carotid artery stenosis is seen in 8% to 18% of patients who undergo coronary artery bypass surgery or other cardiac surgeries. 16,21,22 Therefore, the finding of carotid stenosis might prompt further evaluations for clinically silent coronary artery disease in some cases.…”

Section: Ultrasound For Carotid Artery Diseasementioning

confidence: 99%

Atherosclerotic Peripheral Vascular Disease Symposium II

Criqui¹,

Alberts

Fowkes³

et al. 2008

Circulation

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“…Duplex sonography constitutes the most common imaging method for screening patients undergoing major vascular and cardiac surgery [7][8][9][10], but has drawbacks due to technical difficulties, overestimation of lesions in cases of bilateral disease [11], and problems in evaluating occlusions and complex anatomy [12] may be exacerbated by the characteristic abnormalities in flow velocity pattern due, for example, to an aortic stenosis with increased acceleration time, decreased peak velocity and a delayed upstroke [13]. Moreover, true ultrasound imaging is sometimes impended by extensive calcification and the examination is insufficient in maximally 5% of patients with high grade stenosis.…”

Section: Carotid Artery Angiographymentioning

confidence: 99%

Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results

Rigatelli¹,

Rigatelli²

2005

Int J Cardiovasc Imaging

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An aging population makes multiple vascular distributions more likely in patients arriving at the cath lab for coronary artery angiography or complete cardiac catheterization. Whether or not screening angiography of supraaortic vessels can be performed at the time of cardiac catheterization by the invasive cardiologist is still debatable. We sought to determine safety and utility of performing angiography of supraaortic vessels during cardiac catheterization. Medical records of all patients undergoing combined coronary and noncoronary angiography between May 1998 and December 2002 was retrospectively reviewed. One hundred and forty patients (80 males, mean age 67.8 +/- 5.4 years) underwent combined cardiac catheterization and angiography of supraaortic vessels. Carotid artery angiography was performed at the same time of cardiac catheterization in 62 patients and subclavian artery angiography in the other 78 patients. Significant findings were reported in 32 (22.8%) patients. Complications included 1 transient ischemic attack and 2 carotid spasm resolved with nitrates infusion. In most cases the same standard catheters used during coronary angiography were used also for noncoronary angiography (119 patients, 85%). The incidence of significant angiographic findings and the relatively frequent association of CAD with supraaortic vessel atherosclerosis supports combined cardiac catheterization and angiography of supraaortic arteries but only in patients with multivessel coronary artery disease.

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Carotid and aortic screening for coronary artery bypass grafting

Cited by 77 publications

References 20 publications

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

Atherosclerotic Peripheral Vascular Disease Symposium II

Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results

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