Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Vascular Surgery

Background:

• Stroke is a major perioperative risk following coronary artery bypass graft (CABG) surgery, affecting approximately 2% of patients.
• Carotid stenosis (CS) is a significant independent predictor of perioperative stroke in CABG patients.
• Optimal management of CS in CABG candidates remains controversial, with synchronous carotid endarterectomy (CEA) and CABG being a potential surgical approach.

Observation:

• This report details four cases of patients with significant carotid artery stenosis undergoing combined CEA and CABG.
• Patient 1: Female with left internal carotid artery (ICA) stenosis (90%) and right ICA occlusion undergoing CABG post-myocardial infarction.
• Patient 2: Male with right ICA stenosis (90%) and left ICA occlusion undergoing elective CABG.
• Patient 3: Male with right ICA stenosis (>90%) undergoing CABG post-stroke and myocardial infarction.
• Patient 4: Male with bilateral ICA stenosis (>90%) undergoing elective CABG.

Findings:

• The synchronous CEA and CABG procedure was successfully performed in all four presented cases.
• The case series indicates that combined CEA and CABG is a safe and feasible option for managing patients with critical CS undergoing CABG.
• Current evidence and guidelines for managing CS in CABG patients were reviewed.

Implications:

• This case series suggests synchronous CEA and CABG is a safe procedure.
• Further multicenter studies with larger patient cohorts are necessary to validate these findings.
• Clinicians should consider screening high-risk patients for CS to optimize perioperative management and outcomes.