No role for routine carotid doppler ultrasounds to screen for carotid artery stenosis prior to noncardiac surgery
Preface: Carotid artery doppler ultrasound scans are frequently ordered prior to noncardiac surgery to decrease the chance of a perioperative stroke. The assumption is that patients with significant carotid artery stenosis have a higher risk of a perioperative stroke during non cardiac surgery.
The Cleveland Clinic performed a retrospective study of over 2,100 patients who had carotid duplex ultrasound scans performed within 6 months before or 1 month after noncardiac surgery. 37% of the patients had signficant carotid artery stenosis (>50%) and 13% had severe stenosis (>70%), but neither of these groups of patients had an increased incidence of postoperative stroke, mortality, or MI.
This is another study that supports the guidance that screening for carotid artery stenosis prior to noncardiac surgery has no utility.
Sonny A et al. Lack of association between carotid artery stenosis and stroke or myocardial injury after noncardiac surgery in high-risk patients. Anesthesiology 2014 Nov; 121:922.