John David Kehoe , Amber Downes , Aoife Feeley , Sean Barrett , Carl Vaughan , Tara Ni Dhonnchu
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引用次数: 0
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.
导言：颈动脉狭窄是冠状动脉旁路移植术（CABG）后发生脑血管意外的危险因素。指南建议术前使用多普勒超声进行选择性筛查，但非选择性筛查却很普遍。最近的数据对围手术期颈动脉介入治疗的疗效提出了质疑，对这一做法的价值提出了挑战。目的：分析本院在 CABG 术前进行颈动脉 US 评估的效用：这是一项回顾性研究，研究对象是2019年1月至2022年12月期间在爱尔兰一家心脏外科中心接受非急诊CABG手术的所有18岁以上患者：结果：共纳入1161名受试者。1084/1161（93.36%）人接受了US评估。41/1084（3.8%）例血管狭窄≥70%，189/1084（17.5%）例血管狭窄≥50%。32/1084（2.95%）人接受了确诊成像检查，7/1084（0.64%）人接受了颈动脉介入治疗。18/1161（1.55%）和≥70%（P=0.024）和≥50%（P结论：尽管颈动脉US筛查几乎得到了普遍应用，但它只改变了一小部分CABG患者的治疗，这对这一做法的有效性提出了挑战。多支冠状动脉疾病与颈动脉狭窄无关，尽管欧洲指南将其列为筛查标准。必须利用已确定的风险因素开发预测模型，以便进行有针对性的术前筛查。
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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