A retrospective analysis of 1421 consecutive CABG patients identified the following as risk factors for significant carotid artery disease: age 65 years, presence of a carotid bruit, and a history of cerebro- vascular disease.858 In so doing, they reduced preoperative testing by 40%, with only a negligible impact on surgical management or neurological outcomes. Similarly, the follow- ing risk factors have been identified as predicting the pres- ence of 50% reduction in internal diameter of the internal carotid artery: smoking, diabetes mellitus, hypertension, a previous cerebrovascular event, PAD, left main CAD, and a history of cervical carotid disease.859 All subjects found to have significant carotid disease were noted to have 1 of these criteria. In addition, the probability of detecting signif- icant carotid disease increased almost 3 times for each additional criterion that was present. The authors noted that the presence of a single preoperative risk factor increased the sensitivity of the screening test to 100% and increased the specificity to 30%. As a result, they strongly recommend a selective approach to the use of preoperative noninvasive carotid screening, allowing for a decrease in the number of unnecessary tests but exerting little effect on the detection of significant carotid disease. 