J Korean Surg Soc.  2011 Jan;80(1):61-66. 10.4174/jkss.2011.80.1.61.

Comparative Results of Combined Coronary Artery Bypass Grafting and Carotid Endarterectomy versus Staged Operation

Affiliations
  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ywkim@skku.edu
  • 2Department of Thoracic and Cardiovscular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

PURPOSE
Between combined and staged operations of carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) for patients with concurrent coronary and carotid disease, each treatment strategy has its own advantages and disadvantages. We attempted to compare early surgical results between the two operations.
METHODS
We retrospectively reviewed medical records of 71 patients who underwent either combined CEA & CABG (n=37) or staged CABG & CEA (n=34) in a single institute between January 2001 and March 2010. After comparing patients' demographics and preoperative neurologic and cardiac status, we compared early (<1 month) postoperative cardiac or neurologic complications and surgical mortality between the 2 groups.
RESULTS
There was no significant difference in patients' demographics and indications for operation the between 2 groups. There were 2 (5.4%) cases of postoperative stroke in combined groups and 1 (2.9%) in staged group. However, there was no myocardial infarction or death. In staged operation group, during the interval time between the two operations, 5 cases (14.7%) of stroke developed, of which, all patients recovered without any sequelae by anticoagulation.
CONCLUSION
After experiencing low postoperative cardiac or neurologic morbidity or mortality after combined CABG and CEA, we conclude that combined CABG and CEA was a safe and feasible treatment option for patients with neurologic symptoms and in stable cardiac status. In the staged operation group of patients, we observed development of neurologic events during the interval period between CABG and CEA. To attain optimal treatment strategy in asymptomatic patients, further prospective study would be required.

Keyword

Endarterectomy; Carotid artery; Coronary artery bypass

MeSH Terms

Carotid Arteries
Coronary Artery Bypass
Coronary Vessels
Demography
Endarterectomy
Endarterectomy, Carotid
Humans
Medical Records
Myocardial Infarction
Neurologic Manifestations
Retrospective Studies
Stroke

Reference

References

1. Faggioli GL, Curl GR, Ricotta JJ. The role of carotid screening before coronary artery bypass. J Vasc Surg. 1990; 12:724–9. discussion. 729–31.
Article
2. Jausseran JM, Bergeron P, Reggi M, Chiche G, Serra-Rosset G, Courbier R. Single staged carotid and coronary arteries surgery. Indications and results. J Cardiovasc Surg (Torino). 1989; 30:407–13.
3. Ricotta JJ, Wall LP, Blackstone E. The influence of concurrent carotid endarterectomy on coronary bypass: a case-controlled study. J Vasc Surg. 2005; 41:397–401. discussion. 401–2.
Article
4. Perler BA. Managing patients with clinically significant cardiac and carotid artery occlusive disease. Arch Surg. 2009; 144:998–9.
Article
5. Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, Isayev Y, et al. Strokes after cardiac surgery and relationship to carotid stenosis. Arch Neurol. 2009; 66:1091–6.
Article
6. Akins CW, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE, LaMuraglia GM, et al. Late results of combined carotid and coronary surgery using actual versus actua-rial methodology. Ann Thorac Surg. 2005; 80:2091–7.
Article
7. Naylor AR, Cuffe RL, Rothwell PM, Bell PR. A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass. Eur J Vasc Endovasc Surg. 2003; 25:380–9.
Article
8. Naylor AR, Mehta Z, Rothwell PM, Bell PR. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg. 2002; 23:283–94.
9. Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endovasc Surg. 2009; 37:379–87.
Article
10. Bae JS, Lee S, Yoon SS, Choi SH, Park JK, Kim SN, et al. Combined carotid endarteretomy and coronary artery bypass graft: two cases report. J Korean Soc Vasc Surg. 2002; 18:149–55.
11. Lim HI, Lee KB, Sung KI, Lee YT, Kim DI. Surgical approach of concomitant coronary and carotid artery disease. J Korean Surg Soc. 2006; 71:197–201.
12. Brown KR, Kresowik TF, Chin MH, Kresowik RA, Grund SL, Hendel ME. Multistate population-based outcomes of combined carotid endarterectomy and coronary artery bypass. J Vasc Surg. 2003; 37:32–9.
Article
13. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter study of perioperative ischemia research group and the ischemia research and education foundation investigators. N Engl J Med. 1996; 335:1857–63.
14. Das SK, Brow TD, Pepper J. Continuing controversy in the management of concomitant coronary and carotid disease: an overview. Int J Cardiol. 2000; 74:47–65.
Article
15. Naylor AR. The importance of initiating "best medical therapy" and intervening as soon as possible in patients with symptomatic carotid artery disease: time for a radical rethink of practice. J Cardiovasc Surg (Torino). 2009; 50:773–82.
16. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol. 2004; 44:e213–310.
17. Ghosh J, Murray D, Khwaja N, Murphy MO, Walker MG. The influence of asymptomatic significant carotid disease on mortality and morbidity in patients undergoing coronary artery bypass surgery. Eur J Vasc Endovasc Surg. 2005; 29:88–90.
Article
18. Naylor R, Cuffe RL, Rothwell PM, Loftus IM, Bell PR. A systematic review of outcome following synchronous carotid endarterectomy and coronary artery bypass: influence of surgical and patient variables. Eur J Vasc Endovasc Surg. 2003; 26:230–41.
Article
19. Mackey WC, Khabbaz K, Bojar R, O'Donnell TF Jr. Simultaneous carotid endarterectomy and coronary bypass: perioperative risk and long-term survival. J Vasc Surg. 1996; 24:58–64.
Article
20. Mickleborough LL, Walker PM, Takagi Y, Ohashi M, Ivanov J, Tamariz M. Risk factors for stroke in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1996; 112:1250–8. discussion. 8–9.
Article
21. Naylor AR. Managing patients with symptomatic coronary and carotid artery disease. Perspect Vasc Surg Endovasc Ther. 2010; 22:70–6.
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