Reduced morbidity and mortality following carotid endarterectomy: The value of preoperative cardiac screening

Richard E. Carballo, Julie A. Freischlag, Gary R. Seabrook, Robert A. Cambria, Jonathan B. Towne

Research output: Contribution to journalArticle

Abstract

Carotid endarterectomy can be recommended for stroke prophylaxis when performed with low perioperative cardiac morbidity and mortality. In this study the authors evaluate the effectiveness of a cardiac screening protocol using dipyridamole-thallium scintigraphy to identify and treat coexistent coronary artery disease (CAD). The authors reviewed the medical records of 164 patients undergoing carotid endarterectomy between 1988 and 1993 at the John L. Doyne Hospital and at the Zablocki Veterans Administration Hospital in Milwaukee, Wisconsin. Results of the preoperative cardiac evaluations and the incidence of perioperative cardiac events were recorded. Forty patients without any evidence of cardiac disease by history or electrocardiogram went on to surgery without further screening. Eight patients underwent coronary catheterization without dipyridamole-thallium scan, owing to the severity of their cardiac symptoms. A cardiology consultation and dipyridamole-thallium scan were obtained preoperatively in the remaining 116 patients with a history of CAD. Of these 116 patients, 62 (53.4%) were diagnosed as normal. Thirty-five (30%) scans demonstrated reversible reperfusion defects, leading to preoperative coronary angiography in 17 patients and to cardiac revascularizations in 8. Nineteen (16.4%) scans demonstrated a fixed perfusion defect; 3 of these patients underwent coronary catheterization, leading to cardiac revascularization in 1 patient. Of 2 patients (1.7%) who suffered a postoperative myocardial infarction, 1 patient had a fixed perfusion defect and 1 was found to have a two-vessel disease on coronary catheterization. There were no perioperative deaths. In the follow-up period (15.9 months; range one to sixty), no cardiac deaths occurred. With this treatment algorithm using selective dipyridamole-thallium scan evaluation, perioperative and long-term cardiac morbidity and mortality can be minimized.

Original languageEnglish (US)
Pages (from-to)137-142
Number of pages6
JournalVascular Surgery
Volume31
Issue number2
StatePublished - 1997
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Morbidity
Mortality
Dipyridamole
Thallium
Catheterization
Coronary Artery Disease
Perfusion
Veterans Hospitals
United States Department of Veterans Affairs
Cardiology
Coronary Angiography
Radionuclide Imaging
Reperfusion
Medical Records
Coronary Disease
Heart Diseases
Electrocardiography
Referral and Consultation
History

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Carballo, R. E., Freischlag, J. A., Seabrook, G. R., Cambria, R. A., & Towne, J. B. (1997). Reduced morbidity and mortality following carotid endarterectomy: The value of preoperative cardiac screening. Vascular Surgery, 31(2), 137-142.

Reduced morbidity and mortality following carotid endarterectomy : The value of preoperative cardiac screening. / Carballo, Richard E.; Freischlag, Julie A.; Seabrook, Gary R.; Cambria, Robert A.; Towne, Jonathan B.

In: Vascular Surgery, Vol. 31, No. 2, 1997, p. 137-142.

Research output: Contribution to journalArticle

Carballo, RE, Freischlag, JA, Seabrook, GR, Cambria, RA & Towne, JB 1997, 'Reduced morbidity and mortality following carotid endarterectomy: The value of preoperative cardiac screening', Vascular Surgery, vol. 31, no. 2, pp. 137-142.
Carballo RE, Freischlag JA, Seabrook GR, Cambria RA, Towne JB. Reduced morbidity and mortality following carotid endarterectomy: The value of preoperative cardiac screening. Vascular Surgery. 1997;31(2):137-142.
Carballo, Richard E. ; Freischlag, Julie A. ; Seabrook, Gary R. ; Cambria, Robert A. ; Towne, Jonathan B. / Reduced morbidity and mortality following carotid endarterectomy : The value of preoperative cardiac screening. In: Vascular Surgery. 1997 ; Vol. 31, No. 2. pp. 137-142.
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