Should we screen patients for carotid artery disease before lung cancer resection?

Anne Charloux; Cézar Matau; Jérémie Jégu; Olivier Rouyer; Pierre-Emmanuel Falcoz; Elisabeth Quoix

doi:10.21037/jtd-20-1117

Should we screen patients for carotid artery disease before lung cancer resection?

J Thorac Dis. 2020 Nov;12(11):6743-6751. doi: 10.21037/jtd-20-1117.

Authors

Anne Charloux^{1

2}, Cézar Matau³, Jérémie Jégu^{4

5}, Olivier Rouyer¹, Pierre-Emmanuel Falcoz⁶, Elisabeth Quoix²

Affiliations

¹ Department of Physiology and Lung Function Testing, University Hospital of Strasbourg, Strasbourg, France.
² EA 3072, FMTS, Strasbourg University, Strasbourg, France.
³ Department of Pulmonology, University Hospital of Strasbourg, Strasbourg, France.
⁴ Department of Public Health, University Hospital of Strasbourg, Strasbourg, France.
⁵ UMR-S1113, FMTS, Strasbourg University, Strasbourg, France.
⁶ Department of Thoracic Surgery, University Hospital of Strasbourg, Strasbourg, France.

Abstract

Background: Postoperative stroke is a rare complication after lung cancer surgery but has a high mortality rate. No strategy has been recommended to detect carotid artery disease preoperatively in lung cancer patients. The main objective of this study was to evaluate whether a routine carotid duplex ultrasound (DUS) altered the preoperative management of these patients.

Methods: We performed a single-centre, retrospective study of all patients referred for lung cancer resection over a two-year period and reviewed the available carotid DUS results. We quantified the number of carotid artery disease diagnosis, the severity of the disease according to DUS results, and the number of treatments initiated preoperatively. We examined relationships between cardiovascular history and preoperative carotid artery disease diagnosis.

Results: Among the 398 consecutive lung surgery patients, 6% had a preoperative history of stroke or transient ischemic attack, and one developed a postoperative stroke, of cardioembolic origin. Three hundred and seven patients (77%) had preoperative carotid DUS. Carotid DUS results elicited anti-platelet therapy initiation or endarterectomy before lung resection in 7 out of these 307 patients (2.3%). One hundred and seventy-one carotid DUS were retrospectively reviewed by an expert, who diagnosed carotid stenosis >50% and occlusion in 2.3% and 1.2% of patients, respectively. Abnormal carotid DUS was associated with history of lower extremity artery disease (P<0.001), diabetes mellitus (P<0.05) and dyslipidemia (P<0.05).

Conclusions: This retrospective observational study showed that routine preoperative carotid DUS led to few carotid stenosis detection and few perioperative management alterations. Carotid artery disease diagnosis was associated with cardiovascular history and risk factors. Future studies should examine how to select patients who will benefit from a preoperative carotid DUS.

Keywords: Lung cancer; carotid artery disease; cerebrovascular disease; preoperative assessment; stroke.