A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass

Abstract

10-12% of patients undergoing staged or synchronous procedures suffered death or major cardiovascular morbidity (stroke, MI) within 30 days of surgery. Overall, there was no significant difference in outcomes for staged and synchronous procedures and no comparable data for patients with combined cardiac and carotid disease not undergoing staged or synchronous surgery.

Combined Carotid and Cardiac Surgery: Improving the Results

“…Naylor et al have published several thorough reviews of the literature concerning patients presenting with concomitant carotid and coronary disease. [13][14][15][16] In an initial review of 59 studies, they noted that 91% of screened CABG patients had no significant carotid disease and stroke risk in these patients was less than 2%. Stroke risk increased to 3% in predominantly asymptomatic patients with unilateral 50-99% carotid stenosis, 5% in those with bilateral 50-99% carotid disease, and 7-11% in patients with carotid occlusion.…”

“…Overall, they concluded there were no statistically significant differences between the two strategies. 14 High-risk subgroups of patients for post-CABG stroke include not only patients with carotid disease, but also neurologically symptomatic patients, and patients with aortic arch disease. In a review of 9,939 patients in 8 published series, patients with a previous TIA or stroke had an 8.5% risk of perioperative stroke compared with 2.2% stroke risk in those patients who are neurologically asymptomatic.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…Carotid intervention immediately before coronary surgery followed by administration of intravenous heparin between the procedures has not been well evaluated. 344,[346][347][348][349][350][351] In the nonrandomized Nationwide Inpatient Sample of 27,084 patients discharged from 2000 to 2004, 352 fewer major adverse events, postoperative strokes (2.4% versus 3.9%), and combined strokes and deaths (6.9% versus 8.6%; p<0.001) were reported among patients undergoing CAS plus CABG surgery than in those undergoing CEA plus CABG surgery, although rates of in-hospital mortality were similar (5.2% versus 5.4%). Whether the lower rate of complications with CAS than CEA in this population undergoing CABG surgery reflects case selection bias or an intrinsic safety advantage remains uncertain, and properly designed prospective studies are needed.…”

Surgical treatment of patients with coronary artery disease and bilateral carotid lesion

“…Тем не менее имеется множество свидетельств повы-шенного риска развития инсульта и инфаркта в случае одномоментных операций аортокоронарного шунтирова-ния (АКШ) и КЭ [10]. Однако доказательств в пользу вы-полнения реконструкции одного сосудистого бассейна с отсроченной коррекцией другого также нет.…”