scholarly journals Combined Carotid Endarterectomy and Coronary Bypass Grafting: Risk versus Benefit - A Review

1970 ◽  
Vol 6 (1) ◽  
pp. 41-44
Author(s):  
Rezwanul Hoque ◽  
Sabrina Sharmeen Husain ◽  
Zerzina Rahman ◽  
Ashia Ali ◽  
Mostafa Nuruzzaman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Artery Stenosis ◽  
Bypass Grafting ◽  
Postoperative Stroke ◽  
Bilateral Carotid

Carotid Endarterectomy (CEA) performed in combination with coronary artery bypass grafting (CABG) have also increased steadily since Bernhard and colleague’s initial report in 1972. Coexistence of symptomatic coronary artery disease and significant carotid artery stenosis ranges from 3.4% to 22%. The incidence of postoperative stroke after CABG ranges from 0.7% to 5%. Coronary revascularization in a patient with internal carotid artery stenosis more than 50% is associated with a postoperative stroke rate of 6%, which increases significantly to more than 16% when stenosis is more than 90%. To reduce the potential risk for postoperative stroke after CABG in patients with significant or symptomatic carotid artery stenosis, many surgeons have advocated combined CABG with unilateral carotid endarterectomy. However, clinical experience with the concomitant approach is conflicting. On the basis of the long-term results, it is estimated that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity. The overall 30-day mortality of combined CABG with bilateral carotid endarterectomy was 6.1% and that was unrelated to primary cardiac or cerebrovascular events. Favorable outcome also supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients. Key words: Carotid endarterectomy; Coronary Bypass Grafting. DOI: 10.3329/uhj.v6i1.7194University Heart Journal Vol.6(1) 2010 pp.41-44

scholarly journals Concurrent Carotid Endarterectomy and Off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: A Prospective Cohort Study

2018 ◽  
Vol 13 (1) ◽  
pp. 2-7
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Heemel Saha ◽  
Sabita Mandal ◽  
Sanjoy Kumar Saha ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Stenosis ◽  
Off Pump ◽  
Co Morbidity

A patient of ischemic heart disease (IHD) with additional carotid artery stenosis (CAS) has been distinguished as a high risk group for both heart and cerebral inconveniences following surgical intervention. We aimed to review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass graft (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS at our institute.In the vicinity of 2014 and 2016, fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Six (40%) patients had a history of myocardial infarction (MI), four (26.66%) had unstable angina (USAP), and three (20%) had USAP together with MI, though two (13.33%) were asymptomatic. Nine (60%) patients demonstrated no neurological manifestations, three (20%) had transient ischemic assaults (TIAs), two (13.33%) experienced stroke, and 1 (6.66%) experienced both. Majority 7 (46.66%) patients had 75-90% carotid artery stenosis and 6(40%) patients experienced right though 8 (53.33%) experienced left CEA and only 1 (6.66%) had bilateral CEA. Five (33.33%) patients were found left main disease (>50% lesion) and 100% patients have had significant Left Anterior Descending (LAD) lesion in this study. Twelve (80%) patients show significant lesion in Right Coronary Artery (RCA) and ten (66.66%) patients had Obtuse marginal (OM) branch disease. CEA was performed before OPCABG in all cases. There were 15 patients (mean age 62.5±2.8 years; 80% were male), two (13.33%) had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 h and patients were released in 10 days. There was no mortality in the early postoperative period and co-morbidity was less significant (6.6% myocardial ischemia, 13.33% atrial fibrillation, 6.66% TIA, 13.33% Stroke). There was 1 (6.66%) postoperative acute renal failure evidenced by raised serum creatinine level. Two (13.33%) patients showed respiratory complications; only 6.6% of them suffered from wound infection. A combined strategy by means of CEA with OPCABG is safe and savvy in view of the satisfactory consequences of morbidity and mortality rates and also short ICU and hospital stay status.Faridpur Med. Coll. J. Jan 2018;13(1): 2-7

scholarly journals Carotid Artery Stenosis Associated with Increased Mortality in Patients who Underwent Coronary Artery Bypass Grafting: A Single Center Experience

2013 ◽  
Vol 7 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Marcelo P. da Rosa ◽  
Ricardo Schwendler ◽  
Rodrigo Lopes ◽  
Vera L. Portal
Keyword(s):  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Carotid Artery ◽  
Coronary Artery Bypass ◽  
Carotid Artery Stenosis ◽  
Independent Predictor ◽  
Artery Bypass ◽  
Artery Stenosis ◽  
Bypass Grafting

Background: Vascular disease resulting from arteriosclerosis is a severe worldwide health risk. Early diagnosis and intervention is important to control adverse cerebral and cardiovascular events. The aim of this study was to assess the potential predictors of mortality in patients submitted to coronary bypass surgery. Methods: Cohort study included asymptomatic cerebrovascular disease patients scheduled for coronary artery bypass grafting admitted to the cardiology reference center. All patients were submitted to carotid artery ultrasound assessment prior to surgery and were followed up during the entire in-hospital postoperative period. Carotid artery stenosis was considered clinically significant when cross sectional area ≥50%. Significance was set at p <0.05. Logistic regression was used to identify independent predictors of mortality. Results: Of 455 patients with a mean age of 62.2 years 65.6% were males. The prevalence of carotid artery stenosis was 18.7%. It was absent in 3.6% of the patients, below 50% in 77.8%, between 50 and 69% in 11.6%, and between 70 and 99% in 6.9%. The carotid artery was occluded in 0.2% of the sample. An overall mortality of 12%, affecting 35 men (P=0.001) with stenosis ≥50%. After logistic regression analysis, carotid artery stenosis ≥50% was confirmed as being an independent predictor of mortality (P=0.005). Conclusion: In this series carotid artery stenosis showed a high prevalence in the sample assessed and was an independent predictor of mortality.

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