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Published on: May 9, 2013
Coronary artery bypass combined with bilateral carotid endarterectomy
M Dylewski1, C C Canver, J Chanda
1Division of Cardiothoracic Surgery, Albany Medical College, New York 12208-3479, USA.
Insights
Simultaneous coronary artery bypass grafting and bilateral carotid endarterectomy in selected patients showed no strokes and low mortality. This combined procedure is justified for patients with severe carotid stenosis and coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Surgical management for patients needing coronary artery bypass grafting (CABG) with significant bilateral carotid artery stenosis is not well-defined.
- This study reviews preliminary outcomes of CABG combined with bilateral carotid endarterectomy.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous coronary artery bypass grafting and bilateral carotid endarterectomy.
- To assess outcomes in patients with unstable angina and severe bilateral carotid stenosis undergoing combined procedures.
Main Methods:
- Retrospective chart review of 33 patients with >70% bilateral carotid stenosis undergoing simultaneous CABG and bilateral carotid endarterectomy.
- Utilized an eversion technique for carotid endarterectomy.
Main Results:
- The combined procedure was performed urgently in 73% and electively in 27% of patients.
- No postoperative strokes occurred. Overall 30-day mortality was 6.1%, unrelated to cardiac or cerebrovascular events.
- 27% of patients experienced nonfatal postoperative complications; 64% were discharged by postoperative day 10.
Conclusions:
- Favorable outcomes support the justification for performing concomitant CABG with bilateral carotid endarterectomies.
- This combined surgical approach is viable in selected patients with critical coronary and carotid artery disease.
Background:
Surgical management of patients presenting for coronary artery bypass grafting with significant bilateral carotid artery stenosis has not been well defined. In this study, our preliminary results of coronary artery bypass grafting with concomitant bilateral carotid endarterectomy have been reviewed.
Methods:
A retrospective nonrandomized chart review was performed in 33 patients with unstable angina and bilateral carotid artery stenosis, more than 70%, undergoing simultaneous coronary artery bypass grafting and bilateral carotid endarterectomy using an eversion technique.
Results:
Concomitant coronary artery bypass grafting with bilateral carotid endarterectomy was performed urgently in 24 (73%) and electively in 9 (27%) patients. The average carotid artery cross-clamp and total perfusion times were 14.7 +/- 4.9 minutes and 123 +/- 29.2 minutes, respectively. The average length of stay in the cardiopulmonary intensive care unit was 4.2 +/- 14.2 days and total hospital stay was 16.2 +/- 20.5 days. Postoperative in-hospital stay was 14.9 +/- 20.3 days. There were no postoperative strokes. Twenty-one (64%) patients were discharged before the tenth postoperative day. Nonfatal postoperative complications occurred in 27% (9 of 33) of patients. The overall 30-day mortality was 6.1% (2 of 33) and that was unrelated to primary cardiac or cerebrovascular events.
Conclusions:
Favorable outcome supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients.
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