Prevalence of carotid artery stenosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting for coronary artery disease: Role of anesthesiologist in preoperative assessment and intraoperative management

Abstract

Objective(s):This study aimed to determine the prevalence of carotid artery stenosis (CAS) due to atherosclerosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting (CABG) for coronary artery disease (CAD). It contemplated a greater role for the cardiac anesthesiologist in the perioperative management of such patients with either previously undiagnosed carotid artery disease or towards re-assessment of severity of CAS.Design:Prospective, observational clinical study.Setting:Operation room of a cardiac surgery centre of a tertiary teaching hospital.Participants:A hundred adult patients with New York Heart Association (NYHA) classification I to III presenting electively for CABG.Interventions:All patients included in this study were subjected to ultrasonic examination by means of acarotid doppler scan to access for presence of CAS just prior to induction of general anesthesia.Measurements and Main Results:Based on parameters measured using carotid doppler, the presence of CAS was defined using standard criteria. The prevalence of CAS was found to be as high as 38% amongst the patients included in our study. The risk factors for CAS were identified to be advanced age, history of smoking, diabetes mellitus, dyslipidaemia and presence of a carotid bruit.Conclusion:This study points towards the relatively wide prevalence of carotid artery disease in neurologically asymptomatic patients undergoing CABG for CAD in the elective setting. It highlights the need to routinely incorporate carotid ultrasonography in the armamentarium of the cardiac anesthesiologist as standard of care for all patients presenting for CABG.

Asymptomatic Carotid Artery Stenosis among Patients with Type II Diabetes Mellitus

“…Diabetes has been demarcated as an independent risk factor for the occurrence of high-grade carotid artery intima-media thickness in the general population. 13 Type-II Diabetes (T2D) carries a considerable risk factor for the advancement of atherosclerosis. It is measured by increase in carotid intimamedia thickness (CIMT).…”

Preoperative Carotid Duplex Scanning in Patients Undergoing Coronary Artery Bypass Grafting

“…However, carotid DUS is more frequently used because it is non-invasive and easily applicable in clinical practice. Taneja et al [28] recommend the incorporation of this commonly available and easy-to-use bedside technique of Doppler examination of the carotid vessels in routine intraoperative practice as the standard of care in all patients undergoing CABG [28] . In our clinic, carotid DUS screening is performed routinely regardless of risk factors in all patients undergoing CABG.…”

Cardiac Surgery in the Older Adult

“…Although there is still controversy regarding the management of asymptomatic carotid disease, it is believed that known carotid disease in the older adult population is a risk factor for postoperative stroke [53,56,68,69]. Morris et al recommended routine preoperative assessment of carotid artery disease in octogenarians and advocated carotid endarterectomy if significant disease is found; however this is still controversial and not the current standard of practice in most cardiac surgery centres [70,71]. If symptomatic carotid artery disease is diagnosed prior to cardiac surgical intervention, consideration can be given to performing a staged or a combined cardiac/carotid procedure.…”