Key result
Carotid endarterectomy should be considered for low-risk, younger patients with significant asymptomatic carotid artery stenosis, but there is no strong evidence it must be performed prior to or during CABG.
Why the study?
Does carotid endarterectomy prior to or during CABG improve outcomes in patients undergoing cardiac surgery with asymptomatic significant carotid artery stenosis?
Does carotid endarterectomy prior to or during CABG improve outcomes in patients undergoing cardiac surgery with asymptomatic significant carotid artery stenosis?
There is no strong evidence to support performing carotid endarterectomy prior to or during CABG in patients with asymptomatic significant carotid artery stenosis.
No change to perioperative strategies warranted in asymptomatic carotid stenosis; leaves open need for randomized data on CEA timing with CABG.
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether asymptomatic significant carotid artery stenosis (ASCAS) warrants carotid endarterectomy (CEA) in patients undergoing cardiac surgery. 128 Papers were found using the reported search, of these 10 presented represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that low risk, younger patients with a significant asymptomatic carotid artery stenosis should be considered for carotid endarterectomy at some stage. There is, however, no strong evidence that this must be performed prior to, or during CABG.
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Michael O. Murphy (2005) conducted a review in Asymptomatic significant carotid artery stenosis in patients undergoing cardiac surgery. Carotid endarterectomy (CEA) vs. No CEA prior to or during CABG was evaluated. Carotid endarterectomy should be considered for low-risk, younger patients with significant asymptomatic carotid artery stenosis, but there is no strong evidence it must be performed prior to or during CABG.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: