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March 1, 1997Vascular Surgery

Hemodynamically Significant Carotid Disease and Prophylactic Carotid Endarterectomy in CABG Patients—Impact on Perioperative Neurologic Events

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Why the study?

Does prophylactic carotid endarterectomy reduce perioperative neurologic events in CABG patients with high-grade carotid stenosis?

Population

427 patients who underwent pre-CABG carotid duplex scan and isolated coronary artery bypass grafting between…

Comparison

Prophylactic carotid endarterectomy for patients… vs No carotid endarterectomy in patients with…

Design

Cohort

Follow-up

perioperative

Authors

GHGeorge L. HinesWSWilliam C. ScottSSScott Schubach

Discussion

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Overview

May support prophylactic carotid endarterectomy before CABG in high-grade stenosis; leaves open need for randomized confirmation.

Key Points

  • To evaluate the relationship between carotid artery stenosis and perioperative neurological events in patients undergoing isolated coronary artery bypass grafting and determine whether prophylactic endarterectomy reduces stroke risk in high-grade lesions.
  • Reviewed hospital courses of 427 patients who underwent preoperative carotid duplex scanning and isolated coronary artery bypass grafting between April 1992 and June 1994.
  • Stratified patients by carotid stenosis severity and whether patients with 80-99% stenosis received pre-bypass or simultaneous carotid endarterectomy versus no endarterectomy.
  • Overall perioperative stroke incidence was 2.58% (11/427), with 64% of all strokes (7/11) occurring in the 34 patients with total occlusion or high-grade carotid stenosis (P < .0001).
  • Strokes occurred in 33.3% (4/12) of patients with unilateral total occlusion and in 21.4% (3/14, plus 1 transient ischemic attack) of untreated 80-99% stenosis patients, compared to 0% (0/12) in patients treated with carotid endarterectomy and 1.03% (4/389) in those without significant carotid disease.

Structured PICO

Does prophylactic carotid endarterectomy reduce perioperative neurologic events in CABG patients with high-grade carotid stenosis?

P
Population
427 patients who underwent pre-CABG carotid duplex scan and isolated coronary artery bypass grafting (CABG) between April 1992 and June 1994.
I
Intervention
Prophylactic carotid endarterectomy (either pre-CABG or simultaneous with CABG) for patients with high-grade (80-99%) carotid stenosis.
C
Comparator
No carotid endarterectomy in patients with high-grade (80-99%) carotid stenosis.
O
Outcome
Perioperative neurologic events (cerebrovascular accident/stroke or transient ischemic attack).hard clinical

Prophylactic carotid endarterectomy appears to protect against perioperative neurologic events in patients with high-grade carotid stenosis undergoing isolated CABG.

Cite This Study

Hines et al. (1997) studied this question.

synapsesocial.com/papers/6a730ed4542cb04b60cd5a65https://doi.org/10.1177/153857449703100206
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Also Consider

Synapse has enriched one closely related paper. Consider it for comparative context:

  1. 1Combined carotid and coronary revascularization: The preferred approach to the severe vasculopath1992 · 132 citations