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Published on: May 9, 2013
Outcomes of simultaneous carotid endarterectomy and coronary artery bypass grafting: A single centre experience
Aleksandras Antuševas1, Adomas Aladaitis1, Linas Velička1
1Clinic of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Insights
Simultaneous carotid endarterectomy and coronary artery bypass grafting (CEA/CABG) is effective for high-risk patients. Smoking and prior myocardial infarction increase stroke and complication risks after this combined procedure.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Stroke is a known complication of coronary artery bypass grafting (CABG), with carotid artery disease being a significant risk factor.
- Patients undergoing CABG often have underlying carotid artery stenosis, increasing their perioperative stroke risk.
- Simultaneous carotid endarterectomy (CEA) and CABG is an option to mitigate stroke risk in these high-risk individuals.
Purpose of the Study:
- To evaluate preoperative and intraoperative risk factors for myocardial infarction (MI), stroke, and death after simultaneous CABG/CEA.
- To assess early postoperative complications following the combined procedure.
Main Methods:
- A retrospective analysis of 134 patients who underwent simultaneous CABG/CEA between 2015 and 2019.
- Inclusion criteria involved elective CABG for significant coronary artery disease and asymptomatic or symptomatic carotid stenosis.
- The primary endpoint was the 30-day risk of stroke and death.
Main Results:
- Simultaneous CEA/CABG demonstrated acceptable outcomes in high-risk patients.
- Predictors of postoperative stroke included smoking, history of MI, prior CABG, and stroke/TIA.
- Major postoperative complications were associated with cardiac arrhythmia, previous MI, and smoking.
Conclusions:
- The synchronous CEA/CABG procedure is a viable option for patients at high risk of stroke.
- This combined approach can be safely performed in elderly patients (septuagenarians and older).
Objective:
Stroke following a coronary artery bypass surgery is a well-known complication often predisposed by carotid artery disease. Perioperative risk of stroke after on-pump cardiac surgery can overall affect 2% of patients. Patients with 80-99% unilateral carotid artery stenosis carry a 4% risk of stroke. Significant carotid artery stenosis is present in 3-10% of patients who are candidates for coronary artery bypass grafting (CABG). Those patients might be considered for either simultaneous or staged carotid endarterectomy and CABG to reduce the risk of stroke and death. The purpose of this study was to evaluate preoperative and intraoperative risk factors for myocardial infarction (MI), stroke and death and assess complications occurring during the early postoperative period after simultaneous CABG/CAE procedure.
Methods:
A single centre retrospective analysis of 134 patients from 2015 to 2019 who underwent simultaneous CABG/CEA was performed. At the same period, a total of 2827 CABG were performed, of which 4.7% were simultaneous interventions. We excluded staged CEA/CABG procedures, off-pump CABG and urgent CABG patients. All patients included in the study met the criteria for elective CABG for triple-vessel or left main trunk symptomatic coronary artery disease (CAD) with asymptomatic >70% carotid stenosis or symptomatic ipsilateral >50% carotid stenosis regardless of the degree of contralateral carotid artery stenosis. Patient demographics, comorbidities and operative details were reviewed. The primary endpoint was to assess the intraoperative and 30-day risk of stroke and death after simultaneous CEA/CABG procedure.
Results:
Simultaneous CEA/CABG is effective procedure that can be performed in high-risk symptomatic patients with acceptable results. Predictors of postoperative stroke were smoking (P = 0.011), history of MI (P = 0.046), history of CABG (P = 0.013), and history of stroke/TIA (P = 0.005). Significant risk factors for adverse major postoperative complications after simultaneous CEA/CABG procedure were cardiac arrhythmia (AF or AFL) (P = 0.045), previous MI (P < 0.001), and smoking (P = 0.001).
Conclusions:
Synchronous CEA/CABG procedure can be performed with acceptable results in patients having a high risk of stroke, septuagenarians and older.
