Cardiovascular Journal of Africa: Vol 32 No 3 (MAY/JUNE 2021)

19 / 66

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021 AFRICA 129
A comparison of two different management plans for
patients requiring both carotid endarterectomy and
coronary artery bypass grafting
Ata Niyazi Ecevit, Okay Guven Karaca, Mehmet Kalender, Murat Bekmezci, Mehmet Ali Sungur,
Osman Tansel Darçın
Abstract
Background: Carotid endarterectomy (CEA) is a prophy-
lactic operation that is used to mitigate the risk of stroke
caused by embolism of atherosclerotic plaques in the carotid
bifurcation. Previously, the large, multicentre, randomised,
controlled GALA study found no significant differences
in clinical outcomes between patients treated using general
or local anaesthesia. While this study provided important
insights into disease outcomes based on treatment modali-
ties, it did not answer questions regarding the safety of
CEA under local anaesthesia in patients at high risk for
cardiovascular complications. Here, we examined the use of
two different management plans in patients requiring both
carotid endarterectomy and coronary artery bypass grafting
(CABG), in terms of their effects on hospital mortality.
Methods: Thirty-four patients consecutively operated on in
our cardiovascular department were included in this analysis.
The patients were divided into two groups based on the anaes-
thetic management plan. The first group consisted of patients
who underwent CEA and CABG under general anaesthesia
in the same session (GA group); the second group consisted
of patients who initially underwent CEA under cervical block
anaesthesia followed by CABG under general anaesthesia in
a separate session (CB-GA group). These two groups were
compared in terms of postoperative complications and hospi-
tal mortality.
Results: The incidence of postoperative myocardial infarction
was higher in the CB-GA group, with four patients experi-
encing postoperative myocardial infarction, compared to no
patients in the GA group.
Conclusion: For patients requiring CEA and CABG, perform-
ing both operations under general anaesthesia in the same
session was safer than initially performing CEA under
cervical block anaesthesia followed by CABG under general
anaesthesia.
Keywords: carotid endarterectomy, cervical block anaesthesia,
general anaesthesia, coronary artery bypass grafting
Submitted 15/6/20, accepted 14/9/20
Published online 16/3/21
Cardiovasc J Afr 2021; 32: 129–132
DOI: 10.5830/CVJA-2020-042
Carotid endarterectomy (CEA) is a prophylactic operation that
is used to mitigate the risk of stroke caused by embolism of
atherosclerotic plaques in the carotid bifurcation.1,2 In two large
studies, the North American Symptomatic Endarterectomy
Trial (NASCET) and the European Carotid Surgery Trial
(ECTS), CEA was recommended, particularly in symptomatic
patients who have more than 70% stenosis of the carotid
artery.3,4 However, the overall mortality rate for CEA was
reported to be 1.3–1.8% in two large systematic reviews in
which the highest rate was 15%5,6
In the GALA study, the largest multicentre, randomised,
controlled trial of its kind to date, CEA under general
anaesthesia (GA) and local anaesthesia (LA) were compared,
with the authors finding no significant differences between
the methods in terms of stroke, myocardial infarction (MI), or
death in the first 30 days following surgery. 7 However, despite
the scope of the trial, the GALA study was not able to answer
the questions regarding the safety of CEA performed under LA
in patients at high risk for cardiovascular complications.
The aim of this study was to compare two different
management plans in patients requiring both CEA and
coronary artery bypass grafting (CABG) in terms of their
effects on hospital mortality. For the first management plan,
patients were initially treated by CEA under cervical block
(CB) anaesthesia, followed by CABG administered under GA
in a separate session. For the second management plan, both
CEA and CABG were performed in the same session under
GA.
Bilkent City Hospital, Yuksek Ihtısas Cardiovascular
Surgery Hospital, Ankara, Turkey
Ata Niyazi Ecevit, MD,
Department of Cardiovascular Surgery, Medical Faculty of
Duzce University, Duzce, Turkey
Okay Guven Karaca, MD
Department of Cardiovascular Surgery, Derince Traning
and Research Hospital, Kocaeli, Turkey
Mehmet Kalender, MD
Dr Ali Kemal Belviranlı Obstetric and Gynecology Hospital,
Konya,Turkey
Murat Bekmezci, MD
Department of Biostatistics and Medical Informatics,
Medical Faculty of Duzce University, Duzce, Turkey
Mehmet Ali Sungur, MD
Department of Cardiovascular Surgery, Antalya Traning
and Research Hospital, Antalya, Turkey
Osman Tansel Darçın, MD