Routine epiaortic ultrasound scanning is reasonable to evaluate the presence, location, and severity of plaque in the ascending aorta to reduce the incidence of atheroembolic complications.847 849 (Level of Evi- dence: B) Identification of an atherosclerotic aorta is believed to be an important step in reducing the risk of stroke after CABG.850 Intraoperative assessment of the ascending aorta for detection of plaque by epiaortic ultrasound imaging is superior to direct palpation and TEE.851,852 Predictors of ascending aortic atherosclerosis include increasing age, hypertension, extracardiac atherosclerosis (peripheral ar- tery and cerebrovascular disease), and elevated serum creatinine concentrations.853 855 Prospective RCTs to eval- uate the role of epiaortic scanning in assessing stroke risk have not been reported, but several observational studies reported stroke rates of 0 to 1.4%847 849,853,856,857 when surgical decision making was guided by the results of epiaortic scanning. Separate guidelines for the use of intraoperative epiaortic ultrasound imaging in cardiac surgery were endorsed and published in 2008 by the American Society for Echocardiography, Society of Car- diovascular Anesthesiologists, and STS.147 5.2.1.1.2. The Role of Preoperative Carotid Artery Noninva- sive Screening in CABG Patients: Recommendations Class I 1. A multidisciplinary team approach (consisting of a cardiologist, cardiac surgeon, vascular surgeon, and neurologist) is recommended for patients with clin- ically significant carotid artery disease for whom CABG is planned. (Level of Evidence: C) Class IIa 1. Carotid artery duplex scanning is reasonable in selected patients who are considered to have high- risk features (ie, age >65 years, left main coronary stenosis, PAD, history of cerebrovascular disease [transient ischemic attack [TIA], stroke, etc.], hyper- tension, smoking, and diabetes mellitus).858,859 (Level of Evidence: C) Hillis et al 2011 ACCF/AHA CABG Guideline e687 2. 