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Is carotid screening redundant for patients undergoing coronary artery bypass grafting?
Author(s) -
Volpi Sara,
Ali Jason M.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14771
Subject(s) - medicine , bypass grafting , asymptomatic , incidence (geometry) , guideline , artery , stroke (engine) , stenosis , complication , cohort , medline , surgery , pathology , mechanical engineering , physics , political science , law , optics , engineering
Objectives Stroke is a devastating complication following coronary artery bypass grafting, which thankfully occurs with low incidence. The role of preoperative carotid ultrasound remains unclear. Whilst it is a cheap and reliable way of diagnosing carotid stenosis (CS), it is unclear if and how this knowledge should impact on subsequent patient management. Methods A systematic review of the literature was performed using the PRISMA guideline. A literature search was conducted on the MEDLINE database from 1950 to May 2020 using the OVID interface. Fifteen papers out of a total of 5931 were identified for inclusion. Results The evidence overall suggests that patients with severe CS are likely to have an increased incidence of postoperative stroke—however, the prevalence of severe CS is low, and even in this cohort of patients, the incidence is not particularly high. Conclusion In screened patients identified to have severe CS, there appears to be a generally low appetite for undertaking carotid intervention internationally either before or concurrently with the coronary artery bypass grafting. Putting this all together, the widespread screening of asymptomatic patients would appear to not be justified.