Carotid endarterectomy prior to ventricular assist device placement

Area of Science:

• Cardiovascular Surgery
• Neurology
• Transplant Surgery

Background:

• Debate exists on optimal timing for carotid endarterectomy (CEA) relative to coronary artery bypass grafting (CABG).
• Ventricular assist device (VAD) patients, particularly those bridged to transplant, introduce unique considerations regarding stroke risk.
• Mechanical circulatory support and cerebrovascular health require careful management in end-stage heart failure patients.

Observation:

• A patient with severe carotid artery disease was evaluated for elective ventricular assist device (VAD) placement.
• The patient required intervention for carotid stenosis prior to VAD implantation to mitigate stroke risk.
• This clinical scenario highlights a novel challenge in managing combined cardiovascular and cerebrovascular disease.

Findings:

• The study reports the first instance of performing CEA in a patient with severe carotid disease immediately preceding elective VAD implantation.
• The procedure was successfully completed without immediate complications.
• This demonstrates the technical feasibility of combined CEA and VAD procedures.

Implications:

• Performing CEA before VAD placement may be a viable strategy to reduce perioperative stroke risk in select patients.
• This approach could enhance outcomes for patients undergoing mechanical circulatory support as a bridge to transplantation.
• Further research is warranted to establish guidelines for combined CEA and VAD procedures.