Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: a retrospective study

Abstract

Background: Our retrospective single-center study aimed to evaluate the safety of the carotid endarterectomy (CEA) in comparison to patients with untreated asymptomatic carotid stenosis ≥60% before CABG. Methods: This single-center retrospective study included 174 patients with asymptomatic unilateral carotid stenosis treated between 2004 and 2017 with CABG. Thereof 106 patients had CEA before cardiac surgery either by a simultaneous (n = 62) or staged (n = 44) approach. Patients with untreated carotid stenosis served as control (no-CEA group; n = 68). Results: The mean stenosis grade was higher in the CEA group (CEA 83% (±1), no-CEA 71% (±1) p < 0.0001). The overall stroke rate was 5/174 (3%) and was due to a high incidence of stroke in the no-CEA group (CEA: 0/106 (0%); No-CEA 5/68 (7%) p = 0.0083). The overall mortality was 1% and comparable between the groups (CEA: 2/106 (2%); No-CEA 0/68 (0%) p = 0.5211). Stroke related mortality was not observed. The groups were similar regarding the incidence of myocardial infarction (p = 1.0), atrial fibrillation (p = 0.1931), delirium (p = 0.2106) and IMC/ICU stay (p = 0.1542). No significant difference in the subgroup analysis was found between the simultaneous and staged approach regarding the myocardial infarction (simultaneous: 1/62 (1%); staged: 1/44 (1%); p = 1.0). Conclusions: CEA performed as a staged procedure in local anesthesia or a simultaneous procedure in general anesthesia, may reduce the stroke risk prior to CABG.

Outcomes of simultaneous carotid endarterectomy and coronary artery bypass grafting: A single centre experience

“…Mario Lescan with colleagues showed that patients without CEA before CABG surgery had a 7.4% incidence of stroke. 26 It is comparable with Illuminati et al results, which showed that patients in CABG followed by CEA group had an 8.8% incidence of stroke within 90 days in comparison to 1% in CABG with previous or simultaneous CEA group. 17 In our study, 12 patients had a stroke during a postoperative period (9%).…”

Early detection of large‐vessel occlusion stroke after cardiac surgery using CT angiography leading to early recanalization with endovascular thrombectomy

“…It is important to note that it might be difficult to evaluate neurological findings and detect the onset time of stroke accurately under the influence of anesthetics after surgery. It has been suggested and advised against treating relevant carotid stenosis prior to cardiac surgery 10,11 . The decision for carotid angioplasty or endarterectomy not to treat the occluded carotid artery may depend upon patency of the Circle of Willis.…”

“…It has been suggested and advised against treating relevant carotid stenosis prior to cardiac surgery. 10,11 The decision for carotid angioplasty or endarterectomy not to treat the occluded carotid artery may depend upon patency of the Circle of Willis. In this case, carotid angioplasty or endarterectomy should have been performed prior to CABG to avoid critical neurological complications.…”

Surgical Treatment of Severe Carotid Artery Stenosis in Conjunction with Coronary Artery Stenosis

“…The stroke rate is approximately 3.8%, which is significantly higher than that of staged CEA and CABG surgery, which has a perioperative stroke rate of only 0.2 %. As a result, some researchers believe that CEA followed by CABG staging can significantly reduce the risk of perioperative stroke in patients with unilateral asymptomatic carotid artery stenosis and coronary artery disease (19). However, it has been reported that staged CEA and CABG surgery may result in an increased risk of AMI (20).…”