Should severe monolateral asymptomatic carotid artery stenosis be treated at the time of coronary artery bypass operation?

Gaudino, Mario; Glieca, Franco; Luciani, Nicola; Cellini, Carlo; Morelli, Mauro; Spatuzza, Paola; Mauro, Michele Di; Alessandrini, Francesco; Possati, Gianfederico

doi:10.1016/s1010-7940(01)00665-0

Cited by 29 publications

(7 citation statements)

References 16 publications

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“…However, by the 34 th month, neurologically based mortality and morbidity increased in patients in the only CABG group ( Figure 3 ), but it remained similar in patients in other groups ( Figure 2 ). The only other study on this particular issue conducted by Gaudino M. et al [ 26 ] reported similar results for their 139 patients. They observed an increase in neurological events in only CABG patients with severe asymptomatic and unilateral carotid stenosis at the mid-term follow-up period.…”

Section: Discussionsupporting

confidence: 62%

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

Güney¹,

Güler²,

Albay³

et al. 2022

Braz J Cardiovasc Surg

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Introduction There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34 th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, “most threatened organ priority’’ was considered as clinical parameter.

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Section: Discussionsupporting

confidence: 62%

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

Güney¹,

Güler²,

Albay³

et al. 2022

Braz J Cardiovasc Surg

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“…In a study of 139 consecutive patients with severe, unilateral, asymptomatic CAS undergoing CABG (73 patients having no carotid artery surgery and 66 patients having CEA), Gaudino et al 21 reported no differences in the inhospital rates of stroke (0% versus 0%; Pϭ1.0) or mortality (1.4% versus 1.5%; PϾ0.05). However, during follow-up (Ͼ5 years), more patients in the no carotid surgery group developed cerebral events ipsilateral to the CAS (24.3% versus 1.6%; PϽ0.0001), whereas 18% required carotid surgery.…”

Section: Discussionmentioning

confidence: 99%

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Mahmoudi

Hill

Zhang

et al. 2011

Stroke

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Background and Purpose— Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain. Methods— A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed. Patients with severe CAS (n=117) were compared with those without severe CAS (n=761) to assess the rates of stroke and mortality during hospitalization for CABG. The 30-day mortality rate was also assessed. Results— Patients with severe CAS were older and had a higher prevalence of peripheral arterial disease and heart failure. Patients with severe CAS had similar rates of in-hospital stroke (3.4% versus 3.6%; P =1.0) and mortality (3.4% versus 4.2%; P =1.0) compared with patients without severe CAS. The 30-day rate of mortality was also similar between the 2 cohorts (3.4% versus 2.9%; P =0.51). Conclusions— Severe CAS alone is not a risk factor for stroke or mortality in patients undergoing CABG. The decision to perform carotid imaging and subsequent revascularization in association with CABG must be individualized and based on clinical judgment.

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“…Nevertheless D'Agostino et al showed that the risk of perioperative stroke is <2% in patients with carotid stenosis <50%, 10% with stenosis of 50% to 80%, and 11% to 19% with stenosis >80% 13 . A recent study 14 concluded also that the treatment, either staged or simultaneous, of unilateral asymptomatic carotid artery stenosis, at the time of CABG, confers significant neurological protection during the years after surgery. Patients with coronary artery disease and carotid artery stenosis are different from patients with isolated carotid artery stenosis because they are more seriously ill and clinically compromised; therefore, it is not completely right to draw conclusions from the randomized studies about carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Carotid and Coronary Arteries Disease: Staged or Combined Surgical Approach?

Chiappini

Dell’Amore

Marco

et al. 2005

Journal of Cardiac Surgery

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Should severe monolateral asymptomatic carotid artery stenosis be treated at the time of coronary artery bypass operation?

Abstract: The concomitant treatment (either staged or simultaneous) of SMACS at the time of CABG does not influence the in-hospital results, but confers significant neurological protection during the years after the operation.

Cited by 29 publications

References 16 publications

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Simultaneous Carotid and Coronary Arteries Disease: Staged or Combined Surgical Approach?

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