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Role of Preoperative Carotid Duplex Ultrasound in Patients with Severe Aortic Stenosis Referred for Intervention
Session:
SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
Speaker:
Mariana Duarte Almeida
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.7 Imaging - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Duarte Almeida; Francisco Rodrigues Santos; Oliver Correia Kungel; João Gouveia Fiuza; Gonçalo Marques Ferreira; Nuno Craveiro
Abstract
<p><span style="font-size:12px">Introduction: Routine screening for carotid artery stenosis is not recommended in the general population but is advised in certain scenarios, such as preparing for coronary artery bypass grafting (CABG) and for high-risk populations were a prevalence of >20% os carotid stenosis is estimated. However, no formal recommendations exist for patients undergoing evaluation for valvular heart disease. While carotid artery screening may provide important insights, routine screening might not always be necessary, as it can increase costs and delay intervention. <span style="font-family:Aptos,sans-serif"><span style="color:#000000">Carotid duplex ultrasound (DUS) is the first-line modality for screening.</span></span></span></p> <p><span style="font-size:12px"><span style="color:#000000"><span style="font-family:Aptos,sans-serif">Purpose: This study assessed the diagnostic and therapeutic implications of carotid DUS as a preoperative screening tool in patients with severe aortic stenosis (AS) referred for valve replacement.</span></span></span></p> <p><span style="font-size:12px"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Methods: Patients who underwent transthoracic echocardiography from January to September 2022 with severe high-gradient AS and referred for valve intervention were included. Demographic, imaging, and clinical data were collected. Group comparisons were performed using the Chi-square test.</span></span></span></p> <p><span style="font-size:12px">Results: Of the 65 included patients, 33 (50.8%) were females with a mean age of 74.4 ± 8.3 years old. Risk factors for carotid stenosis included hypertension (80%), dyslipidemia (84.6%), diabetes (53.8%), coronary artery disease (29.2%), cerebrovascular disease (9.2%), smoking (6.2%), and peripheral arterial disease (4.6%). Regarding carotid assessment, 58 patients (89.2%) underwent supra-aortic angiography during coronary angiography, 33 (50.8%) underwent carotid DUS, and 28 (43.1%) underwent both. Carotid DUS did not reveal additional findings beyond angiography. Significant carotid pathology was identified in 14 patients (23%): high-risk plaques (16.1%) and stenosis (16.1%)—50% stenosis in 55.6%, 70% in 33.3%, and 90% in 11.1%. Only one patient was referred for vascular surgery, and no vascular interventions were performed. </span>Among the included patients, 40 (61.5%) were classified as high-risk for carotid stenosis, and notably, 64.3% of the significant findings were identified within this group.<span style="font-size:12px"> <span style="font-family:Aptos,sans-serif"><span style="color:#000000">There was no significant association between carotid screening indication and significant findings (p=0.861). Significant carotid pathology was not associated with perioperative complications (p=0.928), but no perioperative strokes occurred.</span></span></span></p> <p><span style="font-size:12px"><span style="color:#000000"><span style="font-family:Aptos,sans-serif">Conclusions: Carotid artery disease screening in patients referred for aortic valve intervention identified significant pathology in approximately one-quarter of cases, but this did not result in vascular interventions. While carotid screening may aid cardiovascular risk modification through medical management, its routine use in AS patients offers no clear added value compared to targeted screening in high-risk individuals. More studies are needed to assess its impact, particularly on perioperative outcomes.</span></span></span></p>
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