Pre-operative carotid screening: Should we screen for the screening exam?

Introduction/Patient Description

In our institution, carotid duplex has become a routine pre-operative exam, especially for cardiac surgery patients. A carotid exam is done with the expectation that intervention will take place when results fall in the 80-99% stenosis category. We wanted to investigate the utility of this exam by looking at distribution of disease in this patient population.

Methods

Using the Philips IntelliSpace Cardiovascular PACS analytics tool, we performed a finding code search of the exam results for patients who had carotid ultrasounds with a ‘pre-operative evaluation’ as the indication for testing. The exam results were divided into 5 categories; no disease, < 50%, 50-79%, 80-99%, and occluded.

Results

There were 2799 patients that had pre-op carotid studies between Jun 2015 and Sep 2019. 36% were undergoing CABG, 21% aortic valve surgery, 7% cardiac transplant, 7% myectomy, and 29% were a combination of unspecified cardiac surgery, orthopedic, peripheral vascular, or other general surgery. 1.4% (n=39) of the patients had internal carotid stenosis (ICA) that fell in the 80-99% category and there were a total of 4 (0.1%) ICA occlusions. 17% (n=475) of patients had 50-79% ICA stenosis, leaving 81.5% of patients in the < 50% or no disease categories.

Conclusion/Discussion

Pre-operative carotid testing is an important tool to potentially reduce the peri-operative stroke risk. Because the number of patients in the 80-99% category was low, further investigation of patient demographics and risks factors should be considered for pre-operative carotid screenings.

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