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[Carotid endarterectomy in patients with coronary heart disease]

Erling Aarsaether1, Øystein K Moe, Per Erling Dahl

  • 1Avdeling for hjerte-/lunge- og karkirurgi, Universitetssykehuset Nord-Norge, 9038 Tromsø. erling.johan.aarsaether@unn.no

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|November 9, 2005
PubMed

Insights

Patients undergoing combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) have similar perioperative risks as those undergoing isolated CEA. This combined procedure is safe for patients with widespread atherosclerosis.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Anesthesiology

Background:

  • Patients with combined coronary and carotid artery disease face high stroke risk after CABG and myocardial infarction risk after CEA.
  • Some institutions perform combined CABG and CEA during a single anesthetic period for symptomatic patients.
  • This approach aims to mitigate risks associated with sequential procedures.

Purpose of the Study:

  • To evaluate the perioperative safety and outcomes of combined CABG and CEA.
  • To compare the risks of combined procedures with isolated CEA in patients with coronary artery disease.

Main Methods:

  • Retrospective review of medical records for patients undergoing combined CABG and CEA (n=37) between 1986-2004.
  • Comparison with patients undergoing isolated CEA (n=118) during the same period.
  • Analysis of perioperative outcomes including stroke, myocardial infarction, and death.

Main Results:

  • The combined procedure group had higher prevalence of peripheral artery disease, atrial fibrillation, and contralateral carotid occlusion.
  • Stroke occurred in 5.4% of the combined group and 4.2% of the isolated CEA group.
  • Perioperative myocardial infarction and 30-day mortality rates were similar between groups, with a lower cumulative risk in the combined group (8.1% vs 11.0%).

Conclusions:

  • Combined CABG and CEA appears to have comparable perioperative risk to isolated CEA.
  • This holds true despite a higher burden of generalized atherosclerotic disease in patients undergoing the combined procedure.
  • The combined approach may be a safe option for select patients with severe coronary and carotid artery disease.
Abstract

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