Published in Anesthesiology 2014 Nov.
Authors: Sonny A et al.
A retrospective study suggests no association.
Does carotid artery stenosis predispose patients who undergo noncardiac, noncarotid surgery to perioperative stroke? To find out, Cleveland Clinic researchers performed this retrospective study.
During a 5-year period, 2110 patients who underwent noncardiac surgery had carotid duplex ultrasonography performed within 6 months before or 1 month after surgery. Thirty-seven percent of patients had at least one carotid stenosis estimated at >50% (as measured by internal carotid artery peak systolic velocity), and 13% of patients had >70% stenosis. Neither of these cutoffs for carotid artery stenosis was associated with elevated risk for in-hospital postoperative stroke or 30-day all-cause mortality. Moreover, carotid artery stenosis was not associated with postoperative myocardial injury.
This retrospective study has several limitations: Subtle perioperative neurological or cardiac events might have been missed, we don’t know exactly why carotid ultrasonography was ordered for these patients, and a small group of patients who underwent carotid revascularization after ultrasonography (and before noncardiac surgery) was excluded. However, the results suggest — albeit indirectly — that screening for carotid artery stenosis before noncardiac surgery has no value.