Simultaneous Carotid Endarterectomy and Cardiac Surgery: Early Results of 386 Patients

 

 Buy Article Permissions and Reprints All articles of this category

Abstract

Background The occurrence of severe carotid artery disease in more than 12% of patients requiring coronary artery bypass grafting (CABG) results in a discrepancy concerning best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement (VR) and simultaneous carotid endarterectomy (CEA).

Methods We retrospectively evaluated 386 patients after simultaneous operation between 7/1994 and 9/2010. Total 326 patients received isolated CABG, 56 CABG and/ or VR, 4 aortic surgery. Mean age was 68.3 years (range: 45 to 87). Male patients were 229. Severity of stenosis at operated side was 70 to 80% in 167, 80 to 99% in 219 patients. Total 164 patients showed bilateral carotid stenosis, 32 had contralateral occlusion. We analyzed risk factors, morbidity, incidence of neurological events, and 30-day mortality.

Results Perioperative stroke with hemiplegia occurred in 10 patients (2.6%). Three patients experienced PRIND, seven TIA. A 30-day mortality was 5.2%. Total 8 deaths were cardiac related, 10 due to extracardial reasons, and 2 patients developed a cerebral death.

Conclusions Simultaneous CEA and cardiac surgery can be performed with a low risk for neurological complications and acceptable mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications.

Note

Presented at the 40th annual meeting of the German Society for Thoracic and Cardiovascular Surgery on February 13 to 16, 2011 in Stuttgart and at the 128th congress of the German Society for Surgery on May 3 to 6, 2011 in Munich, Germany.

• References

• 1 Bull DA, Neumayer LA, Hunter GC , et al. Risk factors for stroke in patients undergoing coronary artery bypass grafting. Cardiovasc Surg 1993; 1 (2) 182-185
  PubMedGoogle Scholar
• 2 Naylor AR, Cuffe RL, Rothwell PM, Bell PRF. A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass. Eur J Vasc Endovasc Surg 2003; 25 (5) 380-389
  CrossrefPubMedGoogle Scholar
• 3 Poldermans D, Bax JJ, Boersma E , et al. Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Noncardiac Surgery: European Society of Cardiology (ESC). Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Eur Heart J 2009; 30 (22) 2769-2812
  CrossrefPubMedGoogle Scholar
• 4 Khaitan L, Sutter FP, Goldman SM , et al. Simultaneous carotid endarterectomy and coronary revascularization. Ann Thorac Surg 2000; 69 (2) 421-424
  CrossrefPubMedGoogle Scholar
• 5 Evagelopoulos N, Trenz MT, Beckmann A, Krian A. Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients. Cardiovasc Surg 2000; 8 (1) 31-40
  CrossrefPubMedGoogle Scholar
• 6 Ederle J, Featherstone RL, Brown MM. Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: a Cochrane systematic review. Stroke 2009; 40 (4) 1373-1380
  CrossrefPubMedGoogle Scholar
• 7 Ederle J, Dobson J, Featherstone RL , et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (Internal carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375: 985-997
  CrossrefPubMedGoogle Scholar
• 8 Chaturvedi S, Bruno A, Feasby T , et al; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005; 65 (6) 794-801
  CrossrefPubMedGoogle Scholar
• 9 Wijns W, Kolh P, Danchin N , et al. Guidelines on myocardial revascularization. The Task Force on Myocardial Revaskularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery. Eur Heart J 2010; 31: 2501-2555
  CrossrefPubMedGoogle Scholar
• 10 Grabitz K, Ommer A, Schmitt HH, Gams W, Sandmann W. Simultaneous intervention for occlusion of the internal carotid artery and coronary disease-reasonable or highrisk combination?. Dtsch Med Wochenschr 2001; 126 (17) 485-490
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Busch T, Sirbu H, Aleksic I , et al. Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians—a comparative study. Eur J Cardiothorac Surg 1999; 16 (6) 602-606
  CrossrefPubMedGoogle Scholar
• 12 Rizzo RJ, Whittemore AD, Couper GS , et al. Combined carotid and coronary revascularization: the preferred approach to the severe vasculopath. Ann Thorac Surg 1992; 54 (6) 1099-1108 , discussion 1108–1109
  CrossrefPubMedGoogle Scholar
• 13 Daily PO, Freeman RK, Dembitsky WP , et al. Cost reduction by combined carotid endarterectomy and coronary artery bypass grafting. J Thorac Cardiovasc Surg 1996; 111 (6) 1185-1192 , discussion 1192–1193
  CrossrefPubMedGoogle Scholar
• 14 Van der Heyden J, Suttorp MJ, Bal ET , et al. Staged carotid angioplasty and stenting followed by cardiac surgery in patients with severe asymptomatic carotid artery stenosis: early and long-term results. Circulation 2007; 116 (18) 2036-2042
  CrossrefPubMedGoogle Scholar
• 15 Brott TG, Hobson II RW, Howard G , et al; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363 (1) 11-23
  CrossrefPubMedGoogle Scholar
• 16 Kouchoukos NT, Daily BB, Wareing TH, Murphy SF. Hypothermic circulatory arrest for cerebral protection during combined carotid and cardiac surgery in patients with bilateral carotid artery disease. Ann Surg 1994; 219 (6) 699-705 , discussion 705–706
  CrossrefPubMedGoogle Scholar
• 17 Stol M, Haman GF. Die zerebrovaskuläre Reservekapazität. Der Nervenarzt 2000; 73: 711-718
  PubMedGoogle Scholar
• 18 Reith W, Pfadenhauer K, Loeprecht H. Significance of transcranial Doppler CO2. Reactivity measurements for the diagnosis of hemodynamically relevant carotid obstructions. Ann Vasc Surg 1990; 4 (4) 359-364
  CrossrefPubMedGoogle Scholar
• 19 Baiou D, Karageorge T, Spyt T, Naylor AR. Patients Undergoing Cardiac Surgery with Asymptomatic Carotid Stenoses have a Low Risk of Peri-operativ Stroke. Eur J Vasc Endovasc Surg 2009; 38 (5) 556-559
  CrossrefPubMedGoogle Scholar