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Combined coronary artery bypass and carotid endarterectomy: long-term results
Daniel Char1, Salvador Cuadra, John Ricotta
1Department of Surgery, Division of Vascular Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA. cdanieljay@aol.com
Insights
Combined coronary artery bypass and carotid endarterectomy (CAB/CEA) offers good long-term survival and stroke prevention. Patients with combined coronary and carotid disease benefit from prophylactic CEA, even with asymptomatic lesions, for excellent long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
Background:
- Combined coronary artery disease and carotid artery disease pose significant risks.
- Surgical intervention for both conditions simultaneously is a complex consideration.
Purpose of the Study:
- To evaluate late survival, freedom from stroke, and freedom from cardiac events in patients undergoing combined coronary artery bypass and carotid endarterectomy (CAB/CEA).
Main Methods:
- Retrospective review of 154 patients undergoing CAB/CEA between 1994 and 1999.
- Follow-up data collected via office records and telephone interviews.
- Life table analysis used to determine endpoints including mortality, stroke, and cardiac events.
Main Results:
- A 3.9% postoperative stroke rate and 13% late mortality rate were observed.
- Five-year survival probability was 80%, with 98% freedom from late stroke.
- Freedom from late cardiac events at 5 years was 82%.
Conclusions:
- Combined CAB/CEA is a viable option for patients with combined coronary and carotid artery disease, offering good long-term survival.
- Prophylactic carotid endarterectomy (CEA) should be considered for stroke prevention, even in asymptomatic carotid lesions.
- Successful CAB/CEA demonstrates excellent long-term freedom from stroke and good freedom from cardiac events.
Purpose:
We determined late survival, freedom from late stroke, and freedom from late cardiac events in patients treated by combined coronary artery bypass and carotid endarterectomy (CAB/CEA).
Methods:
All patients who underwent CAB/CEA in our institution between January 1994 and December 1999 were identified. Follow-up data were obtained from office records and telephone interviews. Endpoints included death from any cause, stroke, and non-fatal cardiac events (MI, CHF, percutaneous transluminal angioplasty with stenting, redo CAB). Data were expressed in life table format.
Results:
Over a 6-yr period 154 patients had combined CAB/CEA with a 3.9% postoperative stroke rate. Six patients (3.9%) died, leaving 148 patients for follow-up. Average follow-up was 38 +/- 23 months (range: 1-82 months). During the follow-up period two patients (1.4%) had late strokes and 17 patients (11%) had late non-fatal cardiac events. The late mortality rate was 13% (19 patients). Of the late mortalities, four were related to cardiac disease and one to stroke. Using Kaplan-Meier analysis, the 5-yr survival probability was 80 +/- 4.3%. The freedom from late ipsilateral neurologic events was 98 +/- 1.3% at 5 yr. The freedom from late cardiac events was 82 +/- 4.6% at 5 yr.
Conclusions:
The large majority of patients with combined coronary and carotid artery disease can be expected to live for greater than 5 yr. Therefore, these patients should be considered candidates for prophylactic CEA for stroke prevention, even when their carotid lesions are asymptomatic. Successful CAB/CEA provides good long-term survival and freedom from late cardiac events, as well as excellent freedom from late stroke. Further reduction in perioperative events will make this operative approach even more attractive in patients with combined disease.