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Prospective evaluation of combined carotid and coronary surgery
L Lusiani1, A Visona, V Castellani
1Institute of Clinical Medicine, University of Padova, Italy.
Insights
Combined carotid and coronary artery surgery is safe but not always necessary for coronary artery bypass grafting (CABG) candidates. Preoperative screening for carotid artery stenosis can guide surgical decisions, reducing unnecessary interventions.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) carries a risk of neurological disturbances.
- Carotid artery stenosis is a known risk factor for stroke.
Purpose of the Study:
- To evaluate the effectiveness of combined carotid and coronary surgery in preventing neurological complications after CABG.
- To determine the necessity of routine screening for carotid disease in CABG candidates.
Main Methods:
- 144 consecutive CABG candidates were screened for carotid stenosis using Doppler ultrasonography.
- Patients were divided into groups undergoing combined surgery or CABG alone.
- Neurological and cardiac complications were monitored postoperatively.
Main Results:
- 18% of CABG candidates had significant carotid stenosis.
- Only 1.5% of survivors developed transient neurological disturbances.
- No patients with significant carotid stenosis who underwent only CABG developed neurological symptoms.
Conclusions:
- Combined carotid and coronary surgery is safe but not indicated for all CABG candidates.
- Systematic combined surgery for CABG patients with significant carotid stenosis is not recommended.
- Noninvasive carotid screening can inform surgical strategy for CABG patients.
Abstract:
In order to evaluate the effectiveness of combined carotid and coronary surgery in reducing the incidence of neurological disturbances after coronary artery bypass grafting (CABG), 144 consecutive candidates for CABG (group I) were screened for carotid disease noninvasively with Doppler ultrasonography (duplex). Twenty-six (18%) were considered at risk for stroke because of a severe (above 50% diameter reduction) stenosis; 20 (4 symptomatic and 16 asymptomatic) underwent combined surgery. Forty-seven other patients (group II) underwent CABG surgery without previous Doppler investigation. Only three patients (1.5% of the survivors) developed transient neurological disturbances after surgery; two who had normal internal carotid arteries belonged to group I, and one to group II. None of the six patients at risk for stroke who underwent only CABG developed neurological symptoms. The incidence of intra- and postoperative cardiac complications of the group who had CABG only compared to that of the group with combined surgery. We conclude that, although safe, combined surgery is not to be performed systematically on candidates for CABG with a significant internal carotid artery stenosis.