Carotid Ultrasound Screening in Patients Undergoing Cardiac Surgery

pp 489-496

Abstract

Since the mid 60's a controversial issue has risen about the fact if it is necessary to know the carotid status of patients submitted to major cardiac surgery. This controversy continues nowadays. Many authors emphasize its necessity, but other reports failed to demonstrate it. The incidence of neurologic deficits following cardiac surgery is present as either stroke or transient ischemic attacks, which have been reported with different ranges. Brain blood flow deficit is one of the most frequent causes of morbidity and mortality related to cardiac surgery. Age, prior neurologic events, severe degree of atheromatosis in ascend-ing aorta or in intra and extracranial arteries, long-time cardiopulmonary bypass and severe perioperative or postoperative hypotension are factors thought to predispose to ischemic neurologic complications. Carotid ultrasound screening is a low cost, high sensitivity/specificity and non-invasive method which allows to identify the severe carotid stenosis symptomatic group of patients, who are at high risk for ischemic brain injury following major cardiac procedures. On the other hand, asymptomatic patients with high degree of carotid stenosis have a low, but non neglectable incidence of neurologic deficits after cardiac surgery, and their risk increases in the longterm period. Carotid ultrasound also shows the plaque morphology, identifying the homogeneous and the heterogeneous ones. Although the last one is related more frequently to intraplaque hemorrhage in symptomatic patients, it indicates also an alert for the asymptomatic patients. In conclusion, carotid ultrasound is a non invasive and low cost screening method allowing to identify, with high sensitivity and specificity, the stenosis degree and the plaque morphology. It should be the policy to apply it to patients over 60 years old, neurologically symptomatic or not, undergoing cardiac surgery.