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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1999 December;40(6):829-36

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

The utility of selective screening for carotid stenosis in cardiac surgery patients

Hill A. B., Obrand D., Steinmetz O. K.

From the Division of Vascular Surgery, McGill University Montreal, Quebec, Canada


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Pur­pose. To deter­mine if any of 8 cat­e­gor­ical clin­ical var­i­ables can be ­used to ­select ­patients and ­improve the ­yield of a ­screening pro­gram for ­severe ­carotid sten­osis (≥ 80%) in elec­tive car­diac sur­gery ­patients.
­Methods. A pros­pec­tive ­cohort anal­ysis of 200 con­sec­u­tive ­patients ­prior to elec­tive car­diac sur­gery for the fol­lowing var­i­ables: age, ­gender, ­smoking, ­carotid ­bruit, periph­eral vas­cular dis­ease, hyper­lip­i­daemia, pre­vious neu­ro­logic symp­toms and dia­betes mel­litus. All ­patients ­were sub­se­quently ­screened ­with ­carotid ­duplex scan­ning for the pres­ence of ­severe ­carotid sten­osis. Pos­i­tive ­scans ­were con­firmed by angio­graphy.
­Results. Six­teen ­patients (8%) ­were iden­ti­fied ­with ­severe ­carotid sten­osis. Uni­var­iate anal­ysis iden­ti­fied ­three var­i­ables ­that ­increase ­risk for ­carotid sten­osis: ­carotid ­bruit (rel­a­tive ­risk (RR)=16.4, 5.4-57.6 95% con­fi­dence ­interval, p<0.001), neu­ro­log­ical his­tory (RR=10.3, 3.9-23.2, p<0.001) and periph­eral vas­cular dis­ease (RR=5.3, 1.9-14.9, p<0.001). Step­wise ­logistic regres­sion anal­ysis iden­ti­fied pre­vious neu­ro­logic his­tory and ­carotid ­bruit as inde­pen­dent pre­dic­tors of sten­osis. If ­screening for ­carotid sten­osis was lim­ited to ­patients ­with ­these two var­i­ables, ­then 37 (18.5% of ­total) ­patients ­would ­have ­been ­screened. Four­teen of ­these 37 (37.8%) had a ­severe ­carotid sten­osis. Two ­patients ­with sten­osis (12.5% of ­those ­with ­carotid sten­osis, 1% of ­total ­patient pop­u­la­tion) ­would not ­have ­been ­screened.
Con­clu­sions. Clin­ical var­i­ables can be ­used to ­improve the ­yield of a pre­op­er­a­tive ­screening pro­gram for ­carotid sten­osis.

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