Improved outcome of carotid endarterectomy: role of preoperative cardiac assessment

ABSTRACT

Thirty-five patients indicated for carotid enderterectomy CEA were exposed to a battery of noninvasive cardiac assessment including clinical history and examination [CE], treadmill exercise testing [TET], and myoview nuclear scanning [MS]. As' a gold standard reference technique, coronary arteriography was' per/armed for each patient after noninvasive evaluation. The sensitivity of CE was low [6/%], Treadmill exercise testing proved to be more sensitive [69%] and highly .specific [89%] but feasible only in [63%] with total accuracy of [77%]. Myoview .scanning demonstrated higher .sensitivity [87%] and less specificity [82%] with high feasibility [94%] and diagnostic accuracy [85%]. Thirteen patients [37%] required coronary revascularization prior to CEA; two of them were clinically classified at moderate risk with false negative TET and MS. There was no postoperative [one month] cardiac death and overall survival after 3 years' was 85.7%. Combined modality approach for cardiac risk assessment is reliable for identification of patients who will benefit from coronary revascularization prior to carotid endarterectomy, and may thus improve the perioperative outcome: