Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting

Abstract

This study suggests that previous or simultaneous CEA in patients with unilateral severe asymptomatic carotid stenosis undergoing CABG could prevent stroke better than delayed CEA, without increasing the overall surgical risk.

Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A Randomized Clinical Trial

“…1 For day 30 and year 1, absolute and relative frequencies; for time-to-event analysis, 1-year Kaplan-Meier estimates; for length of hospital and ICU stay, mean and SD. 2 For day 30 and year 1, relative risk; for time-to-event analysis, unadjusted hazard ratios for treatment variable from Cox proportional hazards regression; missing effect sizes either not available or not calculated; 3 Confirmatory analysis of the primary endpoint was based on the Wald test statistic; for day 30 and year 1, exact Monte Carlo estimation for χ 2 test P values; for time-to-event analysis, log-rank test P values; for DemTect scale difference, length of hospital stay and ICU stay exact Wilcoxon-Mann-Whitney test P values. 4 Technical failure of intervention can only be measured for the synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) arm.…”

“…Two previous (bi-respectively monocentric) RCTs comparing synchronous CEA and CABG with delayed CEA after CABG suggested a lower perioperative risk of stroke in patients undergoing synchronous CEA and CABG compared with delayed CEA after CABG alone. 3,4 In these studies, however, the very low 30-day risk of stroke or death in the synchronous CEA and CABG arm (1% and 2.8%, respectively) is contradictory to a systematic review and large observational studies and therefore unlikely to represent routine clinical practice. 9,18,20 Conclusions on the safety of isolated CABG should be made with caution.…”

Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

“…Staged procedures expose the patient to the increased risk of developing a stroke if they undergo CABG with untreated carotid disease or MI if they undergo CEA with untreated coronary artery disease. Stroke risk has been shown to decrease more for patients staged to CEA before CABG than those staged to CABG before CEA [9]. Staged procedures reduce the stroke risk of CABG patients with carotid disease to that of CABG patients without carotid disease [10].…”

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…W niedawnej RCT u pacjentów z jednostronnym bezobjawowym zwężeniem tętnicy szyjnej wykonywanie najpierw CABG, a następnie CEA było najgorszą strategią, która wiązała się Poziom wiarygodności danych z większą częstością występowania udarów mózgu i zgonów w ciągu 90 dni w porównaniu z CABG z wcześniejszą lub synchroniczną CEA (8,8% vs. 1,0%; p = 0,02) [352]. Wyższe ryzyko zatorowości z blaszek miażdżycowych w łuku aorty do mózgu może tłumaczyć, dlaczego CAS nie wiąże się z mniejszym ryzykiem zabiegowym.…”