Staged carotid and coronary surgery for concomitant carotid and coronary artery disease

Antunes, Pedro E.; Anacleto, Gabriel; Oliveira, João; Eugénio, Luís; Antunes, Manuel J.

doi:10.1016/s1010-7940(01)01097-1

Cited by 44 publications

(29 citation statements)

References 27 publications

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“…Published case series and systematic reviews report complication rates of stroke and death with combined and staged procedures ranging from 2.4% to 17.7%. [17][18][19][20][21][22] Naylor's systematic review suggests that the 30-day stroke risk, including both operative procedures, is 5.4% (CI, 3.4 to 7.2) for a combined and 3.7% (CI, 1.8 to 5.5) for a staged procedure. 5 If we are to include stroke and death from any cause, the respective rates become 9.5% (CI, 7.2 to 11.8) for synchronous and 6.6% (CI, 4.4 to 8.8) for a staged procedure.…”

Section: Discussionmentioning

confidence: 99%

Is There Any Benefit From Staged Carotid and Coronary Revascularization Using Carotid Stents?

Randall

McKevitt

Cleveland

et al. 2006

Stroke

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Background and Purpose-To assess the benefits of carotid artery stenting before coronary artery bypass surgery to reduce the risk of stroke occurring during the cardiac procedure. Methods-A prospective cohort study was performed in patients undergoing carotid artery stenting before coronary artery bypass surgery, or combined bypass and valve replacement procedures, to assess the procedures effectiveness in stroke prevention. Outcome measures including 30-day post stenting and cardiac surgery neurological complication and all-cause mortality rates were assessed. Results-A total of 52 patients were included. Two patients underwent aortic valve replacements at the same time as coronary revascularization. No neurological complications occurred because of the stenting procedure. One cardiac death not related to coronary artery bypass surgery occurred in the 30-day follow-up period for the stent procedure. An additional 6 (11.5%) outcome events (3 strokes and 3 deaths) occurred in the 30-day follow-up period after the cardiac procedure. Three patients died of cardiac causes while awaiting their cardiac bypass procedure. Conclusions-Our results are comparable to those in patients that undergo staged or combined carotid endarterectomy before cardiac surgery. Our small cohort study adds to the limited world literature on the subject but is not sufficiently powered to recommend alterations in practice.

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Section: Discussionmentioning

confidence: 99%

Is There Any Benefit From Staged Carotid and Coronary Revascularization Using Carotid Stents?

Randall

McKevitt

Cleveland

et al. 2006

Stroke

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“…Two Staged operation approach showed less morbidity and mortality because the surgical stress is divided into two parts with a time gap. 4,5,6 But the symptoms of CAD or CAS will be present in the interval period and the patients with acute symptoms can't wait for two staged surgeries. But in combined surgery, there is low incidence of stroke, acute MI, mortality, and cost effective with single anesthesia and reduce hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…As indicated by studies in the writing, 8%-14% of coronary artery bypass grafting (CABG) patients have severe carotid artery stenosis 3,4 and 40%-50% of carotid endarterectomy (CEA) patients have coronary vascular disease5,6. Unfriendly neurologic occasions happened in 6.1% of elective CABG patients who had carotid artery stenosis correspondingly.…”

Section: Carotid Endarterectomymentioning

confidence: 99%

Concurrent Carotid Endarterectomy and off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: a Prospective Cohort Study

Ranjan

Adhikary

Saha

et al. 2018

Anwer Khan Mod Med Coll J

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Background: A patient of ischemic coronary artery 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 review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass grafting (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS in a single surgeons practice. Materials and Methods:In the vicinity of January 2012 and December2016,fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Majority 46.66% patient have 75-90% Carotid artery stenosis and 40%patients experienced right sided lesion, though 53.33% experienced left sided lesion. 33.33% patients were found Left main coronary artery disease (>50% lesion) and 100% patients have had significant LAD lesion in this study. CEA was performed before OPCABG in all cases.Result: Themean age was 62.5±2.8 years; 80% were male. 13.33% had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 hours and patients were released in 10±2 days. There was no mortality in the early postoperative period and co-morbidity was less significant; only 6.6% myocardial ischemia, 13.33% Atrial fibrillation, 6.66% TIA, and 13.33% Stroke. Conclusion: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.Key Words: Carotid artery stenosis (CAS), coronary artery disease (CAD), coronary artery bypass grafting, carotidendarterectomy ABSTRACT kidney disease. 1 Significant blockade (>70% stenosis) of coronary and carotid artery requires surgical intervention. The surgical options for coexisting CAD and CAS include concurrent carotid endarterectomy (CEA) and OPCABG or a sequential approach; two stage operation either CEA followed by OPCABG or OPCABG followed by CEA. Sequential or staged approach demonstrated low morbidity and mortality. Combined approach provides lower incidence of MI, stroke and death as

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“…10, 21,22) However, no well-designed prospective randomized trial has clarified this in this surgically difficult group of patients.…”

Section: Discussionmentioning

confidence: 99%

<b>Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique</b>

et al. 2005

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SUMMARYThe appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. We retrospectively compared our surgical results for 2 types of approaches in this disorder.The records of 76 patients consecutively operated on for carotid and coronary artery disease between August 1993 and October 2004 were reviewed. There were 18 males (66.6%) and 9 females (33.3%) in group I. Group II consisted of 35 males (71.4%) and 14 females (28.5%). The patients were divided into two groups: patients with combined off-pump coronary artery bypass and carotid endarterectomy (group I, n = 27), and those with one-stage on-pump coronary artery bypass and carotid endarterectomy (group II, n = 49). Surgical mortality and morbidity and late outcome were compared among the two groups.The average number of grafts was 1.2 ± 0.4, with the average operative time of 3.3 ± 0.3 hours in group I, and 2.3 ± 0.5 grafts with operative time of 4.6 ± 0.4 hours in group II (P < 0.001 and P < 0.001, respectively). There was 1 death (3.7%) in group I and 2 deaths (4.8%) in group II (P = 0.937). No patient from either group I or group II had postoperative stroke. Mean hospital stay was 7.4 ± 1.9 days in group I and 11.3 ± 1.7 days in group II (P < 0.001). At a mean follow-up of 5.5 ± 3.3 years in group I, 1 patient had contralateral carotid endarterectomy (3.7%). Group II had a mean follow-up of 5.2 ± 3.0 years and contralateral carotid endarterectomy was performed in 1 patient (2.0%). There were no late strokes or deaths in either group.Combined coronary artery bypass grafting and carotid endarterectomy using 2 different types of technique is a safe and effective procedure in patients with significant concomitant monolateral carotid and coronary artery disease. (Int Heart J 2005; 46: 783-793)

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Staged carotid and coronary surgery for concomitant carotid and coronary artery disease

Abstract: Staging of carotid and coronary operations resulted in low global perioperative mortality and morbidity rates in these high-risk patients and is a good alternative therapeutic option.

Cited by 44 publications

References 27 publications

Is There Any Benefit From Staged Carotid and Coronary Revascularization Using Carotid Stents?

Is There Any Benefit From Staged Carotid and Coronary Revascularization Using Carotid Stents?

Concurrent Carotid Endarterectomy and off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: a Prospective Cohort Study

<b>Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique</b>

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