Early Results of Surgical Simultaneous Therapy for Significant Carotid Artery Stenosis and Heart Disease
25 September 2016
21 February 2017
05 April 2017 (eFirst)
Background The purpose of this single-center, retrospective study was to review the early outcome with defined endpoints of myocardial infarction, brain injury, and death after coronary bypass grafting and simultaneous carotid endarterectomy with or without combined valve replacement.
Methods During the preoperative investigation 52 (44 males, 8 females) patients were examined by cardiac catheterization within the scope of their coronary status. In addition, all patients underwent echocardiography, CT angiography of the supra-aortic vessels, and full description of their neurologic status. Included were all patients with the need of coronary revascularization, valve disease, and either symptomatic or asymptomatic carotid artery stenosis with a maximal narrowing of >70%.
Results There was one (2%) patient with a perioperative stroke and paresis of the upper limb. One (2%) patient experienced PRIND (2%). Eighteen (35%) patients suffered symptomatic transitory psychotic syndrome that fully recovered in all patients. One (2%) patient incurred a perioperative myocardial infarction that could be cured by percutaneous coronary stent implantation. Overall mortality was 4%.
Conclusion Simultaneous coronary bypass grafting as a single procedure or in combination with valve replacement and endarterectomy of severe carotid lesions with or without patients' history of previous stroke can be performed with a calculated low surgical risk. The complication rate for neurologic and myocardial events is low compared with the hazard of a single surgical repair. The in-hospital mortality is not significantly different to isolated procedures. The concomitant appearance of coronary stenosis and carotid artery disease is reasonable due to the nature of arteriosclerosis. In our opinion these patients benefit from a combined surgical approach.
Keywordscarotid arteries - cardiopulmonary bypass - coronary artery bypass grafts surgery - coronary artery bypass grafting - neurology/neurologic (deficits - disease - injury) - stroke
- 1 Lane I, Byrne J. Carotid artery surgery for people with existing coronary artery disease. Heart 2002; 87 (1) 86-90
- 2 Dzierwa K, Pieniazek P, Musialek P , et al. Treatment strategies in severe symptomatic carotid and coronary artery disease. Med Sci Monit 2011; 17 (8) RA191-RA197
- 3 van der Vaart MG, Meerwaldt R, Reijnen MM, Tio RA, Zeebregts CJ. Endarterectomy or carotid artery stenting: the quest continues. Am J Surg 2008; 195 (2) 259-269
- 4 Jeng JS, Liu HM, Tu YK. Carotid angioplasty with or without stenting versus carotid endarterectomy for carotid artery stenosis: a meta-analysis. J Neurol Sci 2008; 270 (1-2): 40-47
- 5 Noiphithak R, Liengudom A. recent update on carotid endarterectomy versus carotid artery stenting. Cerebrovasc Dis 2017; 43 (1-2): 68-75
- 6 Gopaldas RR, Chu D, Dao TK , et al. Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting: analysis of 10-year nationwide outcomes. Ann Thorac Surg 2011; 91 (5) 1323-1329 , discussion 1329
- 7 Naylor AR, Cuffe RL, Rothwell PM, Bell PR. A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass. Eur J Vasc Endovasc Surg 2003; 25 (5) 380-389
- 8 Ozen Y, Aksoy E, Sarikaya S , et al. Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery. Cardiovasc J Afr 2015; 26 (1) 17-20
- 9 Guibaud JP, Roques X, Laborde N , et al. Extracorporeal circulation as an additional method for cerebral protection in simultaneous carotid endarterectomy and coronary artery surgical revascularization. J Card Surg 2004; 19 (5) 415-419
- 10 Illuminati G, Ricco JB, Caliò F , et al. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting. J Vasc Surg 2011; 54 (4) 993-999 , discussion 998–999
- 11 Ogutu P, Werner R, Oertel F, Beyer M. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?. Interact Cardiovasc Thorac Surg 2014; 18 (4) 511-518
- 12 Gansera B, Schmidtler F, Weingartner J , et al. Simultaneous carotid endarterectomy and cardiac surgery: early results of 386 patients. Thorac Cardiovasc Surg 2012; 60 (8) 508-516
- 13 Hakl M, Michalek P, Sevcík P, Pavlíková J, Stern M. Regional anaesthesia for carotid endarterectomy: an audit over 10 years. Br J Anaesth 2007; 99 (3) 415-420
- 14 Harrison GJ, How TV, Poole RJ , et al. Closure technique after carotid endarterectomy influences local hemodynamics. J Vasc Surg 2014; 60 (2) 418-427
- 15 Chiariello L, Nardi P, Pellegrino A , et al. Simultaneous carotid artery stenting and heart surgery: expanded experience of hybrid surgical procedures. Ann Thorac Surg 2015; 99 (4) 1291-1297
- 16 Sharma V, Deo SV, Park SJ, Joyce LD. Meta-analysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting. Ann Thorac Surg 2014; 97 (1) 102-109
- 17 Carrel T, Stillhard G, Turina M. Combined carotid and coronary artery surgery: early and late results. Cardiology 1992; 80 (2) 118-125
- 18 Kovacevic P, Redzek A, Kovacevic-Ivanovic S, Velicki L, Ivanovic V, Kieffer E. Coronary and carotid artery occlusive disease: single center experience. Eur Rev Med Pharmacol Sci 2012; 16 (4) 483-490
- 19 Evagelopoulos N, Trenz MT, Beckmann A, Krian A. Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients. Cardiovasc Surg 2000; 8 (1) 31-40