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The impact of coronary artery disease on carotid endarterectomy
Insights
Selective coronary arteriography and coronary artery bypass graft (CABG) based on clinical criteria is safe for patients undergoing carotid endarterectomy (CENDX). This approach demonstrates acceptably low mortality and cardiac morbidity rates.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Preoperative cardiac risk assessment is crucial for patients undergoing carotid endarterectomy (CENDX).
- Coronary artery disease (CAD) is a significant comorbidity affecting outcomes in CENDX patients.
Purpose of the Study:
- To evaluate the safety and efficacy of a selective approach to coronary arteriography and coronary artery bypass graft (CABG) in patients undergoing CENDX.
- To assess the incidence of postoperative cardiac events and mortality in this patient population.
Main Methods:
- A series of 531 CENDX patients were analyzed.
- Preoperative cardiac risk was stratified using clinical criteria.
- Patients with established CAD were selected for further cardiac evaluation and intervention based on clinical guidelines.
Main Results:
- Overall postoperative myocardial infarction (MI) incidence was 2.5%, rising to 4% in patients with symptomatic cardiac disease.
- Overall mortality was 0.9%, with only 23% of postoperative MIs being fatal.
- Neurologic complications occurred in 1.4% of patients, with 70% linked to cardiac events. Combined CENDX and CABG in 4% of patients resulted in one death and one stroke.
Conclusions:
- A selective strategy for coronary arteriography and CABG, guided by clinical criteria, is associated with acceptable mortality and cardiac morbidity in CENDX patients.
- This approach allows for effective management of cardiac risk without compromising surgical outcomes.
Abstract:
In a series of 531 CENDX, preoperative cardiac risk was categorized by clinical criteria. Patients with CAD (history of previous MI, angina, congestive heart failure, and/or electrocardiographic evidence of CAD were selected for more invasive studies based on clinical criteria. The overall incidence of postoperative myocardial infarction was 2.5% and increased slightly to 4% in patients with symptomatic cardiac disease. More importantly, the overall mortality was 0.9% and only 3 of 13 (23%) postoperative myocardial infarctions were fatal. Neurologic complications averaged 1.4% and approximately 70% were related to preceding cardiac events. Twenty-two patients or 4% of the entire series underwent carotid endarterectomy combined with coronary artery bypass graft and this approach was associated with one death and one stroke. Therefore, we conclude that a selective approach to coronary arteriography and subsequent CABG based on clinical criteria is associated with an acceptably low mortality and cardiac morbidity.