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Multistate population-based outcomes of combined carotid endarterectomy and coronary artery bypass

Kellie R Brown1, Timothy F Kresowik, Marshall H Chin

  • 1University of Chicago Robert Wood Johnson Clinical Scholars Progam, USA. krbrown@mcw.edu

Journal of Vascular Surgery
|January 7, 2003
PubMed

Insights

Combined carotid endarterectomy and coronary artery bypass grafting in Medicare patients showed a high stroke and death rate (17.7%). Outcomes were worse than single-institution studies, with delayed stroke diagnosis and non-hemispheric strokes.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Public Health

Background:

  • Management of combined carotid and coronary disease is controversial.
  • Community-wide outcomes for combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are not well-established.

Purpose of the Study:

  • Evaluate community-wide outcomes of combined CEA and CABG.
  • Assess the risk of adverse events associated with combined CEA and CABG.

Main Methods:

  • Reviewed medical records of 10,561 Medicare patients undergoing CEA.
  • Analyzed a subset of 226 patients who had combined CEA and CABG in the same operative event.

Main Results:

  • The combined stroke and death rate was 17.7%, with 80% of nonfatal strokes being disabling.
  • Symptomatic carotid stenosis and aortic arch atherosclerosis were linked to stroke.
  • Female gender, emergent operations, and longer procedure times were associated with mortality.

Conclusions:

  • Community-wide outcomes for combined CEA/CABG in Medicare patients are inferior to single-institution reports.
  • Postoperative stroke diagnosis is often delayed.
  • Most strokes were not limited to the ipsilateral hemisphere of the CEA.
Abstract

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