Carotid Ultrasound Assessment Prior to Coronary Artery Bypass Grafting - An Irish Cardiac Surgery Center's Experience

John David Kehoe; Amber Downes; Aoife Feeley; Sean Barrett; Carl Vaughan; Tara Ni Dhonnchu

doi:10.1016/j.avsg.2024.10.012

Carotid Ultrasound Assessment Prior to Coronary Artery Bypass Grafting - An Irish Cardiac Surgery Center's Experience

Ann Vasc Surg. 2024 Nov 22:111:176-186. doi: 10.1016/j.avsg.2024.10.012. Online ahead of print.

Authors

John David Kehoe¹, Amber Downes², Aoife Feeley³, Sean Barrett², Carl Vaughan⁴, Tara Ni Dhonnchu⁵

Affiliations

¹ Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland; College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland; Royal College of Surgeons of Ireland, Dublin, Ireland. Electronic address: [email protected].
² Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland; Royal College of Surgeons of Ireland, Dublin, Ireland.
³ Royal College of Surgeons of Ireland, Dublin, Ireland.
⁴ College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland; Department of Cardiology, Bon Secours Hospital Cork, Cork, Ireland.
⁵ Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork, Ireland.

PMID: 39581322
DOI: 10.1016/j.avsg.2024.10.012

Abstract

Background: Carotid stenosis is a risk factor for cerebrovascular accident (CVA) following coronary artery bypass grafting (CABG). Guidelines recommend selective preoperative screening with Doppler ultrasound (US) but nonselective application is commonplace. Recent data has questioned the efficacy of perioperative carotid intervention, challenging the value of this practice. We thus aimed to analyze the utility of carotid US assessment prior to CABG in our institution.

Methods: This was a retrospective review of all patients over 18 that underwent a nonemergency CABG in a single Irish cardiac surgery center from January 2019 to December 2022.

Results: 1161 subjects were included. 1084/1161 (93.36%) underwent US assessment. 41/1084 (3.8%) had ≥70% stenosis and 189/1084 (17.5%) had ≥50% stenosis. 32/1084 (2.95%) underwent confirmatory imaging and 7/1084 (0.64%) underwent carotid intervention. Postoperative CVA occurred in 18/1161 (1.55%) and ≥70% (P = 0.024) and ≥50%(P < 0.001) carotid stenosis were associated with same. Chronic kidney disease (odds ratio [OR] = 1.66,P = 0.01), decreasing hemoglobin (OR = 1.13,P = 0.019), increasing age (OR = 1.03,P = 0.011) and being a current (OR = 3.21,P < 0.001) or ex-smoker (OR = 1.82,P = 0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease (CAD) was not associated with carotid stenosis (P = 0.563). Of those that underwent carotid intervention, 0/7 (0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70% (P = 1) or ≥50% (P = 1) carotid stenosis.

Conclusions: Carotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel CAD was not associated with carotid stenosis despite European guidelines listing it as screening criteria. Predictive models must be developed using identified risk factors to enable targeted preoperative screening.