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Pre-operative carotid artery screening in patients undergoing coronary artery bypass grafting


Stroke remains the major non-cardiac complication of coronary artery bypass surgery (CABG). Severe carotid artery disease is associated with a fourfold increase in the risk of post-operative stroke and this is the rationale for offering pre-operative carotid artery screening to these patients.


We aim to assess the compliance with the ESC/EACTS guidelines for Myocardial Revascularisation (2014) regarding pre-operative carotid artery disease screening and estimate the clinical impact of adhering only to class-I evidence-based recommendations.


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


A total of 506 patients underwent CABG during the study period and 492 were included for analysis. 203 carotid artery Doppler ultrasound scans were performed. CAD screening was performed in 63/115 of the patients who met with class-I recommendations (history of stroke/transient ischaemic attack or carotid bruit) and 184/440 of the patients who met with class-IIa recommendations (age over 70 years and/or peripheral artery disease and/or multi-vessel coronary artery disease).

There were 2 post-operative strokes, both in patients without CAD detected on pre-operative screening. Asynchronous carotid artery revascularisation was performed in 5 patients (4 prior to and 1 following CABG).

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.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Pinho-Gomes, AC., Sayeed, R. Pre-operative carotid artery screening in patients undergoing coronary artery bypass grafting. J Cardiothorac Surg 10 (Suppl 1), A20 (2015).

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