Key result
Simultaneous carotid endarterectomy and coronary artery bypass surgery was associated with a 2.67-fold greater adjusted stroke and death rate compared to CABG alone.
Why the study?
Does simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) increase stroke and death in patients requiring CABG with comorbid severe carotid stenosis?
Observational
Yes
Does simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) increase stroke and death in patients requiring CABG with comorbid severe carotid stenosis?
Effect estimate: 2.67-fold greater
Combined CEA-CABG procedures are associated with a 2.67-fold higher adjusted rate of stroke and death compared to CABG alone, highlighting the need for randomized trials to evaluate this approach.
Warrants caution with simultaneous CEA-CABG; leaves open optimal strategy, requiring randomized trials before practice change.
Stroke neurologists are commonly asked to review patients who require coronary artery bypass grafting (CABG) but who also have comorbid severe carotid stenosis; such patients may be offered simultaneous carotid endarterectomy (CEA). In Canada, 0.51% of CABG procedures were combined CEA-CABG. The adjusted stroke and death rate was 2.67-fold greater in the combined CEA-CABG group compared to CABG alone. Randomized trials of the combined procedure are needed.
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Hill et al. (2005) conducted an observational in Severe carotid stenosis requiring coronary artery bypass grafting. Simultaneous carotid endarterectomy (CEA) and CABG vs. CABG alone was evaluated on Stroke and death (2.67-fold greater). Simultaneous carotid endarterectomy and coronary artery bypass surgery was associated with a 2.67-fold greater adjusted stroke and death rate compared to CABG alone.
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