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[Appropriateness of simultaneous carotid endarterectomy and coronary revascularization]

Raoul Borioni1, Ruggero De Paulis, Fabrizio Tomai

  • 1U.O. di Chirurgia Vascolare, European Hospital Via Portuense, 700 00149 Roma E-mail: raoulborioni@alice. it U.O. di Chirurgia Vascolare, Aurelia Hospital, Roma. raoulborioni@alice.it

Giornale Italiano Di Cardiologia (2006)
|April 22, 2008
PubMed

Insights

Synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) is a safe procedure for high-risk patients with both coronary and carotid artery disease. Unstable carotid lesions in asymptomatic patients suggest treating stenoses over 75% before CABG.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Context:

  • Significant carotid artery disease affects up to 17% of patients undergoing coronary artery bypass grafting (CABG).
  • Optimal management for patients with concurrent coronary and carotid artery disease remains debated.
  • This study examines outcomes of synchronous carotid endarterectomy (CEA) and CABG.

Purpose:

  • To analyze the early outcomes of patients undergoing simultaneous CEA and coronary revascularization.
  • To determine the frequency of unstable or ulcerated plaques in symptomatic and asymptomatic patients.

Summary:

  • A review of 68 patients (mean age 71.1 years) undergoing simultaneous CEA and CABG between January 2005 and June 2007.
  • The combined 30-day stroke/mortality rate was 5.8% (3 deaths, 1 stroke).
  • Unstable or ulcerated plaques were found in 60.3% of patients, including 54.7% of asymptomatic individuals with stenosis >75%.

Impact:

  • Combined CEA and CABG can be performed safely in high-risk patients with concomitant coronary and carotid occlusive disease.
  • The high prevalence of unstable carotid lesions in asymptomatic patients supports intervention for stenoses >75% prior to CABG.
  • Carotid artery stenting is cautioned against due to unstable lesions and potential aortic arch atherosclerosis.
Abstract

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