Pre-operative carotid doppler ultrasound scanning among patients who underwent cardiac surgical procedures at queen alia heart institute, is it necessary?

الملخص EN

Objective: To assess the frequency of significant carotid artery disease among the study group patients who underwent cardiac surgical procedures and highlight the importance of pre-operative Carotid Duplex Ultrasonography Scanning.

Methods: This is a descriptive study which was conducted on a consecutive series of 102 Jordanian patients who underwent cardiac surgical procedures at Queen Alia Heart Institute between January and December 2009, and were pre-operatively examined for carotid artery disease.

Median age of the study group patients was 63 (range 40-78) years, there were 84 males and 18 females, 76(74.5%) were hypertensive, 62(60.7%) diabetics, 67(65.6%) had history of smoking, 45(44%) had a Body Mass Index >30, 13(12.7%) had significant left main disease.

Ten patients (9.8%) had a pre-operative history of transient ischemic attack or cerebrovascular accident.

Chi-square was used to determine significance of the study variables, P value<0.05 was considered significant.

Results: Seventeen patients (16.6%) were found to have 50% or greater stenosis of one or both carotid arteries whereas for an 80% or greater stenosis; it was 6(5.8%).

Frequency of a 50% or greater stenosis of one or both carotid arteries was 3(6.5%) in patients between age 60 and 69 years, increasing to 11(42.3%) for patients age of 70 years and older.

Independant risk factors for the presence of >50% stenosis in one or both carotid arteries in this group of patients were a previous history of transient ischemic attack or cerebrovascular accident, left main coronary disease, hypertension, history of smoking.

Among 4 patients found to have concomitant significant carotid lesions and were hemodynamically stable with no critically stenotic coronary arteries, management was staged, carotid stenting was performed as a first stage in 2 patients and carotid endarterectomy was performed as a first stage in another 2 patients, cardiac procedures were performed successfully as a second stage in these 4 patients.

Conclusion: Concomitant significant Carotid Artery Disease among the study group patients above the age of 70 who underwent cardiac procedures is relatively high, selective pre-operative Carotid Duplex Ultrasonography should be mandatory.

Key words: CAS: Carotid Artery Stenosis, CAD: Coronary Artery Disease, CABG: Coronary Artery By- pass Grafting.