Don’t initiate routine evaluation of carotid artery disease prior to cardiac surgery in the absence of symptoms or other high-risk criteria.
|Rationale and Comments:||Studies show that the presence of asymptomatic carotid disease in patients undergoing cardiac surgery does not justify preoperative screening in more than the subgroup of ”high-risk” patients. Carotid stenosis with symptoms (stroke or transient ischemic attacks) is a known risk for cardiovascular accident and appropriate for preoperative testing. High-risk patients have been defined as patients with left main coronary disease, peripheral artery disease, hypertension, smoking, diabetes mellitus, or age older than 65 years due to a higher rate of asymptomatic carotid stenosis in these patients. The presence a carotid bruit does not equate to an increased risk of stroke after cardiac surgery. Patients with carotid stenosis have a higher rate of cerebrovascular complications after cardiac surgery, but there is no evidence that prophylactic or concomitant carotid surgery decreases this rate of complications in asymptomatic patients. Although controversial, the cumulative risk of carotid surgery and cardiac surgery, either sequentially or concomitantly, may exceed the benefit in asymptomatic patients.|
|References:||• Hillis LD, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. Circulation. 2011;124(23):e652-e735.
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