CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
130
AFRICA
Simultaneous coronary artery bypass grafting and
carotid endarterectomy can be performed with low
mortality rates
Ebuzer Aydin, Yucel Ozen, Sabit Sarikaya, Ismail Yukseltan
Abstract
Introduction:
There is controversy over the best approach
for patients with concomitant carotid and coronary artery
disease. In this study, we report on our experience with simul-
taneous carotid endarterectomy (CEA) and coronary artery
bypass graft (CABG) surgery in our clinic in the light of data
in the literature.
Methods:
Between January 1996 and January 2009, a total
of 110 patients (86 males, 24 females; mean age 65.11
±
7.81 years; range 44–85 years), who were admitted to the
cardiovascular surgery clinic at our hospital, were retrospec-
tively analysed. All patients underwent simultaneous CEA
and CABG. Demographic characteristics of the patients and a
history of previous myocardial infarction (MI), hypertension,
diabetes mellitus, hyperlipidaemia, peripheral arterial disease
and smoking were recorded.
Results:
One patient (0.9%) with major stroke died due to
ventricular fibrillation. Peri-operative neurological complica-
tions were observed in seven patients (6%). Complications
were persistent in two patients. Four patients (3%) had
postoperative major stroke, whereas three patients (2%) had
transient hemiparesis. No peri-operative myocardial infarc-
tion was observed.
Conclusion:
Simultaneous CEA and CABG can be performed
with low rates of mortality and morbidity.
Keywords:
coronary artery bypass grafting, carotid endarterec-
tomy, carotid artery disease, coronary artery disease, cerebrovas-
cular event
Submitted 5/2/14, accepted 10/4/14
Cardiovasc J Afr
2014;
25
: 130–133
DOI: 10.5830/CVJA-2014-018
There is controversy over the best approach for patients with
concomitant carotid and coronary artery disease.
1
Therapeutic
strategies include isolated coronary artery bypass grafting
(CABG), staged carotid endarterectomy (CEA) and CABG,
reversed staged CEA and CABG, and simultaneous procedures
under single anaesthesia.
2
Although reported experiences over three decades are
available, combining CEA with CABG remains to be elucidated.
3
Furthermore, risk of cerebrovascular accident (CVA), which is
one of the major predictors of prognosis of CABG, has been
reported to increase up to 14% in patients with severe carotid
artery stenosis (
>
80%).
4-9
Peri-operative neurological events such as stroke after CABG
are the major neurological complications, which increase with
age.
10
The incidence of peri-operative stroke has been well
documented at approximately 2% of all cardiac surgeries.
11
Despite reduced overall complication rates over the years after
CABG, the incidence of stroke remains relatively unchanged.
10
The aetiology of peri-operative stroke is multi-factorial
including hypotension or hypoperfusion-induced reduced brain
flow, atherosclerosis due to micro- or macro-embolisation, and
intra- or extra-cranial vascular diseases.
5
In addition, carotid
artery disease is a critical factor; however, it is considered
unlikely to be the only culprit for peri-operative strokes.
12
Although no consensus on the optimal management of
patients with concomitant carotid and coronary artery disease
has been reached,
13
simultaneous CEA and CABG surgery is
often associated with low rates of mortality and morbidity.
14-17
In
this study, we report our experience with simultaneous CEA and
CABG surgery in our clinic in the light of data in the literature.
Methods
This retrospective study included a total of 110 patients admitted
to the cardiovascular surgery clinic of the Universal Taksim
German Hospital between January 1996 and January 2009. All
patients underwent simultaneous CEA and CABG. Demographic
characteristics of the patients as well as a history of previous
myocardial infarction (MI), hypertension, diabetes mellitus,
hyperlipidaemia, peripheral arterial disease and smoking were
recorded. Carotid artery stenosis was examined using carotid
Doppler ultrasound.
Patients aged
≥
65yearswithperipheral arterydisease, previous
cerebrovascular disease or CEA, symptomatic disease and heart
murmur were candidates for carotid Doppler ultrasound. Half
of the patients underwent a shunting procedure. We performed
CEA in patients with
≥
80% carotid artery stenosis.
All patients were on acetylsalicylic acid and clopidogrel
postoperatively. CEA was performed under general anaesthesia
before CABG. The operation was carried out without shunting
in patients with unilateral lesions and with shunting in those with
bilateral critical stenosis or 100% stenosis unilaterally.
Patients with bilateral critical carotid lesions underwent
surgery for unilateral carotid lesion three days prior to CEA.
Kartal Kosuyolu Training and Research Hospital, Istanbul,
Turkey
Ebuzer Aydin, MD,
Yucel Ozen, MD
Sabit Sarikaya, MD
Taksim German Hospital, Istanbul, Turkey
Ismail Yukseltan, MD
