Is Preoperative Cardiac Testing Indicated Prior to Elective Carotid Endarterectomy?

Abstract

The high incidence of coronary artery disease in patients with peripheral and cerebrovascular occlusive disease has been well established. While preoperative cardiac evaluation has been shown to be beneficial in patients undergoing elective aortic reconstruction, the role of preoperative cardiac testing in patients undergoing elective carotid endarterectomy has not been defined. In this study, the charts of 289 consecutive patients undergoing elective carotid endarterectomy between January 1, 1995, and December 31, 1995, were evaluated to determine the need for cardiac “clearance” prior to surgery. Ages ranged from 48 to 98, with a mean of 70.4 years. The male-to-female ratio was 165:124. Risk factors for coronary artery disease were also assessed: 203 patients (70%) were hypertensive, and 162 patients (56%) gave a history of smoking. An abnormalappearing 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 infarction in the past. No patient presented with unstable angina or angina at rest. No patient underwent coronary artery bypass grafting or coronary artery angioplasty immediately prior to carotid endarterectomy. Of the 289 endarterectomies 154 (53%) were performed under regional anesthesia. All patients were monitored with intraoperative arterial pressure catheters. There were no postoperative deaths. No patient sustained a documented postoperative myocardial infarction. One patient experienced chest pain for 24 hours postoperatively. This patient had a history of angina pectoris and a previous myocardial infarction. One patient had an episode of shortness of breath postoperatively. There were two postoperative strokes. These data suggest that patients with known or suspected coronary artery disease can safely undergo elective carotid endarterectomy without extensive cardiac testing prior to surgery.