Introduction: Treatment of combined coronary artery surgery (CABG) and severe carotid
artery stenosis is still controversial. The decision of surgical priority can
change according to the severity of the coronary artery disease or carotid
artery disease at staged surgery. The aim of the study is to compare the
outcomes of simultaneous surgery (CEA + CABG) and CABG alone at our department. Materials and Methods: We retrospectively reviewed the CABG and CEA +
CABG patients which were performed between 2010 and 2015. If the patients hadsimultaneous
another operation, they were excluded from the study. A total of 294 patients
(252 CABG patients and 42 combined surgery patients), were retrospectively
examined. Results: Two patients in CABG group and two patients in CABG +
CEA group developed stroke. There was no statisticallysignificant
difference between the two groups in terms of early stroke rate (p > 0.05).
One patient in CEA + CABG group and three patients in CABG group died. The average
carotid clamp time was 19.93 ± 5.06 minutes. Aortic clamp times were 42.89 ±
6.38 minutes in CABG and 42.81 ± 5.70 minutes in CEA + CABG patients. Results
of the two groups were similar. Conclusion: Combined CEA and CABG can be
performed successfully and safely in patients.
References
[1]
Borger, M.A., Fremes, S.E., Weisel, R.D., et al. (1999) Coronary Bypass and Carotid Endarterectomy: Does a Combined Approach Increase Risk? A Meta-Analysis. The Annals of Thoracic Surgery, 68, 14-20.
https://doi.org/10.1016/S0003-4975(99)00474-9
[2]
Tarakji, K.G., Sabik, J.F., Bhudia, S.K., Batizy, L.H. and Blackstone, E.H. (2011) Temporal Onset, Risk Factors, and Outcomes Associated with Stroke after Coronary Artery Bypass Grafting. JAMA, 305, 381-390.
https://doi.org/10.1001/jama.2011.37
[3]
Cierie, E., De Rango, P., Maccaroni, M.R., Spaccatani, A. and Cao, P. (2008) Is Hemodynamic Depression during Carotid Stenting a Predictor of Periprocedural Complications? European Journal of Vascular and Endovascular Surgery, 35, 399-404.
[4]
Hertzer, N.R., Loop, F.D., Taylor, P.C. and Beven, E.G. (1978) Staged and Combined Surgical Approach to Simultaneous Carotid and Coronary Vascular Disease. Surgery, 84, 803-811.
[5]
Schwartz, R.L., Garrett, J.R., Karp, R.B. and Kouchoukos, N.T. (1982) Simultaneous Myocardial Revascularization and Carotid Endarterectomy. Circulation, 66, 97-101.
[6]
Peric, M., Huskic, R., Nezic, D., et al. (1998) Combined Carotid and Coronary Artery Surgery: What Have We Learned after 15 Years? Cardiovascular Surgery, 6, 156-165. https://doi.org/10.1016/S0967-2109(97)00145-2
[7]
Fox, A.J., Eliasziw, M., Rothwell, P.M. et al. (2005) Identification, Prognosis, and Management of Patients with Carotid Artery Near Occlusion. American Journal of Neuroradiology, 26, 2086-2094.
[8]
Kaul, T.K., Fields, B.L., Riggins, L.S., Wyatt, D.A. and Jones, C.R. (2000) Coexistent Coronary and Cerebrovascular Disease: Results of Simultaneous Surgical Management in Specific Patient Groups. Cardiovascular Surgery, 8, 355-365.
https://doi.org/10.1016/S0967-2109(00)00027-2
[9]
Obied, H., Miari, A., Alreshidan, M., Alghofaili, F., Ibrahim, M., Albaradai, A. and Koudieh, M. (2014) Incidence & Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery. Open Journal of Thoracic Surgery, 4, 17-20. https://doi.org/10.4236/ojts.2014.42005
[10]
D’Agostino, R.S., Svenssson, L.G., Neuman, D.J., et al. (1996) Screening Carotid Ultrasonography and Risk Factors for Stroke in Coronary Artery Surgery Patients. The Annals of Thoracic Surgery, 62, 1714-1723.
https://doi.org/10.1016/S0003-4975(96)00885-5
[11]
Newhall, K.A., Saunders, E.C., Larson, R.J., Stone, D.H. and Goodney, P.P. (2016) Use of Protamine for Anticoagulation during Carotid Endarterectomy: A Meta-Analysis. JAMA Surgery, 151, 247-255.
https://doi.org/10.1001/jamasurg.2015.3592
[12]
Shishehbor, M.H., Venkatachalam, S., Sun, Z., et al. (2013) A Direct Comparison of Early and Late Outcomes with Three Approaches to Carotid Revascularization and Open Heart Surgery. Journal of the American College of Cardiology, 62, 1948-1956.
https://doi.org/10.1016/j.jacc.2013.03.094
[13]
Gopaldas, R.R., Chu, D., Dao, T.K., et al. (2011) Staged versus Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Analysis of 10-Year Nationwide Outcomes. The Annals of Thoracic Surgery, 91, 1323-1329.
https://doi.org/10.1016/j.athoracsur.2011.02.053
[14]
Yapici, F., Gürer, O., Enc, Y., Cinar, B., Güney, M.R., Yapici, N., Bilgen, F. and Ozler, A. (2002) Combined Surgery for Coronary and Carotid Artery Disease: Management and Results. Journal of Turkish Thoracic and Cardiovascular Surgery, 10, 229-234.