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Carotid endarterectomy and myocardial revascularization. A single stage procedure
L Di Tommaso1, M Caputo, R Ascione
1Department of Cardiac Surgery, University of Naples, Italy.
Insights
Combined carotid endarterectomy (CEA) and coronary artery bypass (CAB) surgery is a safe single-stage approach. This procedure effectively treats severe carotid stenosis in patients with coronary artery disease, minimizing neurological complications.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) and carotid artery stenosis often coexist.
- Surgical management options include staged procedures or a single-stage combined approach.
- The safety and efficacy of single-stage combined procedures require further investigation.
Purpose of the Study:
- To evaluate the outcomes of a single-stage combined carotid endarterectomy (CEA) and coronary artery bypass (CAB) surgery.
- To assess the incidence of neurological complications and mortality in patients undergoing this combined procedure.
Main Methods:
- A retrospective review of 17 patients who underwent a single-stage CEA and CAB procedure over a 4-year period.
- CEA was performed during cardiopulmonary bypass (CPB) under moderate hypothermia.
- Patient demographics, indications for surgery, and perioperative outcomes were analyzed.
Main Results:
- The study included 17 patients (82.3% male, mean age 66.3 years).
- Indications included CAD with >70% carotid stenosis or >50% symptomatic stenosis.
- The mortality rate was 5.8% (one patient died from mediastinitis).
- Minor neurological complications (cerebral edema) occurred in 11.7% of patients.
- No myocardial infarctions or late neurological deficits were observed.
Conclusions:
- Single-stage combined CEA and CAB is a viable option for patients with concomitant CAD and significant carotid stenosis.
- Preoperative screening for carotid disease in CAD patients is crucial.
- This approach can effectively treat both conditions simultaneously, potentially reducing overall morbidity.
Abstract:
Carotid endarterectomy (CEA) and myocardial revascularization can be performed in a single procedure, performing CEA before or during cardio-pulmonary by-pass (CPB), or using a double stage approach. Over a 4 year period, 17 patients underwent CEA and coronary artery by-pass (CAB) with a single stage procedure. Fourteen patients (82.3%) were male, 3 (17.6%) were female. The mean age was 66.3 +/- 7.07. One patient (5.8%) had a previous neurological event (stroke); 5 patients (29.4%) had a previous transient ischemic attacks (TIA). The indications for the combined operations were CAD associated to unilateral internal carotid stenosis greater than 70% or 50% when symptomatic. In all patients CEA was performed after median sternotomy and heparinization, during CPB, with moderate hypotermia (30%C), performing CEA successively. One patient (5.8%) died of acute heart failure secondary to mediastinits. Minor neurological complications were present in 2 patients (11.7%) with signs of cerebral oedema. Myocardial infarction and late neurological deficit did not occur in any patient. We conclude that it is important, in the preoperative assessment of every patients with CAD, the screening for concomitant carotid vascular diseases, in order to avoid neurological complications during CPB, treating the two different diseases with a single stage approach, if carotid stenosis is greater than 70% or greater than 50% when symptomatic.