Prophylactic carotid endarterectomy in patients with high-grade carotid stenosis undergoing coronary bypass: does it...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Perioperative stroke is a serious complication of isolated coronary artery bypass grafting (CABG).
• High-grade internal carotid artery stenosis is a significant risk factor for stroke in CABG patients.

Purpose of the Study:

• To evaluate the impact of prophylactic carotid endarterectomy (CEA) on neurologic outcomes in patients with high-grade carotid stenosis undergoing isolated CABG.

Main Methods:

• Prospective study of 1686 patients undergoing isolated CABG with preoperative carotid duplex scanning.
• Identified 68 patients (4.0%) with 80%-99% carotid artery stenosis.
• Compared outcomes between 15 patients undergoing CABG alone (Group I) and 53 patients undergoing CEA before or during CABG (Group II).

Main Results:

• Group I (no CEA) had 3 permanent (20%) and 1 transient neurologic deficits.
• No neurologic deficits were observed in Group II (prophylactic CEA).
• Statistical analysis showed a significant reduction in total neurologic events (p = 0.001) and permanent deficits (p = 0.005) in Group II.

Conclusions:

• Prophylactic carotid endarterectomy in patients with 80%-99% carotid stenosis undergoing isolated CABG significantly decreases the incidence of postoperative neurologic events.
• CEA is a safe and effective intervention to mitigate stroke risk in this high-risk population.