Is preoperative cardiac testing indicated prior to elective carotid endarterectomy?

The high incidence of coronary artery disease in patients with peripheral a nd cerebrovascular occlusive disease has been well established. While preop erative cardiac evaluation has been shown to be beneficial in patients unde rgoing elective aortic reconstruction, the role of preoperative cardiac tes ting in patients undergoing elective carotid endarterectomy has not been de fined. In this study, the charts of 289 consecutive patients undergoing ele ctive carotid endarterectomy between January 1, 1995, and December 31, 1995 , were evaluated to determine the need for cardiac "clearance" prior to sur gery. Ages ranged from 48 to 98, with a mean of 70.4 years. The male-to-fem ale ratio was 165:124. Risk factors for coronary artery disease were also a ssessed: 203 patients (70%) were hypertensive, and 162 patients (56%) gave a history of smoking. An abnormal-appearing preoperative EKG was identified in 139 patients (48%). Sixty-seven patients (23%) presented with a history of angina pectoris, and 80 patients (28%) had sustained a myocardial infar ction in the past. No patient presented with unstable angina or angina at r est. No patient underwent coronary artery bypass grafting or coronary arter y angioplasty immediately prior to carotid endarterectomy. Of the 289 endar terectomies 154 (53%) were performed under regional anesthesia. All patient s were monitored with intraoperative arterial pressure catheters. There wer e no postoperative deaths. No patient sustained a documented postoperative myocardial infarction. One patient experienced chest pain for 24 hours post operatively. This patient had a history of angina pectoris and a previous m yocardial infarction. One patient had an episode of shortness of breath pos t operatively. There were two postoperative strokes. These data suggest tha t patients with known or suspected coronary artery disease can safely under go elective carotid endarterectomy without extensive cardiac testing prior to surgery.