Multistate population-based outcomes of combined carotid endarterectomy and coronary artery bypass

Abstract

The community-wide outcomes of combined CEA/CABG in the Medicare population are inferior to those reported in many single-institution reviews. Diagnosis of postoperative stroke is often delayed, and most strokes are not limited to the hemisphere ipsilateral to the CEA operative site.

Procedimento combinado entre operação de revascularização do miocárdio e endarterectomia de carótida: análise dos resultados

“…Global incidence of stroke, AMI, and mortality was 4.3%, and 2.2%, respectively. A recent study by Brown et al 50 , involving ten US states, assessed the results of 226 combined procedures (CE + CABG) in patients with mean age of 72.2 Rates of stroke (12%) and mortality (6.7%) were higher than those found in most papers we reviewed, although these values still fall into the variations stated previously. Based on these results, Brown et al 50 emphasize that judgment must be exercised in indicating combined procedure, since most patients reviewed by these authors were asymptomatic in terms of cerebrovascular disease, and that postoperative stroke symptoms were mostly unrelated to the cerebral hemisphere corresponding to the operated side 50 .…”

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%).…”

“…A population-based analysis performed in the United States detected a combined death and stroke rate of 17.7% among 226 procedures. 5 Among 744 patients extracted from the New York Cardiac Database, the combined death and stroke rate was 8.1%. 11 An analysis of all combined surgical procedures performed in Canada, with the exception of the province of Quebec, detected an in-hospital mortality rate of 4.9% and a postoperative stroke rate of 8.5%.…”

Treatment Strategy for Combined Carotid Artery Stenosis and Coronary Artery Disease: Staged or Simultaneous Surgical Procedure?

“…Totally 41,901 patients undergoing simultaneous or staged carotid and coronary procedures were collected from 53 reports (Evagelopoulos et al 2000;Snider et al 2000;Minami et al 2000;Gaudino et al 2001;Hamulu et al 2001;Youssuf et al 2001;Estes et al 2001;Farooq et al 2001;Bonacchi et al 2002;Bonardelli et al 2002;Antunes et al 2002;Zacharias et al 2002;Meharwal et al 2002;Roddy et al 2002;Char et al 2002;Beauford et al 2003;Brown et al 2003;Vitali et al 2003;Ricotta et al 2003;Srimahachota et al 2004;Mishra et al 2004;Ricotta et al 2005;Ziada et al 2005;Cinar et al 2005;Eren et al 2005;Chiappini et al 2005;Akins et al 2005;Nwakanma et al 2006;Inciura and Benetis 2006;Kolh et al 2006;Byrne et al 2006;Cywinski et al 2006;Kovacic et al 2006;Mendiz et al 2006;Randall et al 2006;Chiariello et al 2006;Hertzer and Mascha 2006;Madi-Jebara et al 2006;Kougias et al 2007;Dubinsky and Lai 2007;…”