Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Results in Specific Patient Groups

Management of Patients With Concomitant Severe Coronary and Carotid Artery Disease

“…In the present issue of Circulation, 1 investigators from Nieuwegein in the Netherlands describe in a large group of patients (nϭ356) an alternative revascularization approach: carotid artery stenting (CAS) followed by CABG. The rate of death, stroke, or myocardial infarction (MI) from the time of CAS to 30 days after cardiac surgery (6.8%) compares well with previous surgical series [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table). The associated neurological complication rates were low both at 30 days (major ipsilateral stroke 1.1%) and at a mean follow-up of 31 months (neurological death 1.1% and major ipsilateral stroke 1.1%).…”

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.…”

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

“…Synchronous surgery requires prolonged anesthesia, and several studies have suggested higher rates of stroke and mortality as opposed to staged [3,4,6,8]. 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.…”

“…Due to common risk factors including smoking, diabetes, hyperlipidemia, and resultant atherosclerosis, patients with coronary artery disease often have significant carotid artery disease and vice versa [1,2]. In patients requiring coronary revascularization, 3% to 17% have concomitant severe carotid disease [2][3][4][5], and up to 50% of CEA patients have significant coronary disease [6]. Dual disease confounds perioperative morbidity, specifically the risk of myocardial infarction (MI) post-CEA and stroke post-CABG [3,7].…”