Objective

Stroke remains a major complication of coronary artery bypass surgery (CABG). Severe carotid artery disease (CAD) is associated with an increased risk of post-operative stroke and this is the rationale for offering pre-operative carotid artery screening to those patients. We aimed to assess the compliance with ESC/EACTS guidelines for Myocardial Revascularisation (2014) for pre-operative CAD screening and estimate the impact of restricting screening to class-I evidence-based recommendations.

Methods

The medical records of all the patients who underwent CABG between the 1st January and the 31st December 2014 were retrospectively reviewed.

Results

A total of 506 patients underwent CABG during the study period and 203 of them underwent carotid artery Doppler ultrasound scanning. CAD screening was performed in 63/115 of the patients who met with class-I recommendations and 184/440 of the patients who met with class-IIa recommendations. There were 2 post-operative strokes, both in patients without CAD. Asynchronous carotid artery revascularisation was performed in 5 patients (4 prior to and 1 following CABG).

Conclusion

Restricting carotid artery screening to class-I evidence-based recommendations criteria would have decrease the number of Doppler ultrasound scans from 203 to 115, without missing patients with CAD who actually required revascularisation. Adherence to class-I evidence-based recommendations for carotid artery screening would generate major efficiency savings and streamline pre-operative assessment of patients undergoing CABG.