IS ROUTINE CAROTID SCREENING FOR CORONARY SURGERY NEEDED

An association between carotid and coronary artery disease is well rec ognized, Routine preoperative duplex carotid screening of all coronary surgery patients is common, but may delay surgery and increase cost, To evaluate such a policy: A retrospective review of the records of 30 8 consecutive patients undergoing coronary surgery at one hospital was performed, Duplex studies were done on 210. A history of TIA/RIND, CV A, AS-PVD, AAA, neck bruit, or prior carotid surgery was considered su ggestive for carotid disease, The history and/or physical exam (HPE) s uggested carotid disease in 114; 37 of these (32%) had a positive scan , Of 96 patients without +HPE, three (3%) had a significant stenosis, A prospective study of cardiac surgery patients was done, categorized into ''carotid'' (n = 33) or ''no-carotid'' (n = 50) disease by two in dependent observers, based on +HPE, Positive scans were found in 27 pe r cent of the ''carotid disease'' group; No positive scans were found in the ''no-carotid disease'' group, We conclude that coronary surgery patients with peripheral or cerebral vascular disease or a neck bruit should have preoperative carotid studies, Duplex carotid screening of all cardiac surgery patients is neither medically efficient nor cost- effective.