Pre-operative carotid doppler ultrasound scanning among patients who underwent cardiac surgical procedures at Queen Alia Heart Institute, is it necessary?

ABSTRACT

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. 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. 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. 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