Key result
Combined CABG and carotid revascularization carries a ~9% stroke or death risk, challenging asymptomatic benefit.
Why the study?
The management of patients with concurrent carotid and cardiac disease is controversial due to lack of consensus in guidelines and poor-quality natural history data.
Does CABG plus staged or synchronous CEA or CAS reduce procedural stroke or death compared to isolated CABG in asymptomatic patients with concurrent carotid and cardiac disease?
Does CABG plus staged or synchronous CEA or CAS reduce procedural stroke or death compared to isolated CABG in asymptomatic patients with concurrent carotid and cardiac disease?
The high risk of procedural stroke or death with combined CABG and carotid interventions in asymptomatic patients challenges current practice and suggests isolated CABG may be safer.
May warrant caution for combined procedures in asymptomatic patients; leaves open need for randomized trials to confirm benefit.
The management of patients with concurrent carotid and cardiac disease remains enduringly controversial. National and international guidelines provide no real consensus, and there is poor-quality natural history data to inform the debate. Systematic reviews suggest that coronary artery bypass grafting (CABG) plus either staged or synchronous carotid endarterectomy (CEA) or carotid artery stenting (CAS) are associated with a 9% risk of procedural stroke or death. Given that about 90% of these procedures are performed in asymptomatic individuals, it is questionable whether any benefit is actually being conferred to the patient. A few contemporary studies have now shown that the risk of stroke in neurologically asymptomatic patients with a unilateral 70% to 99% stenosis undergoing an isolated CABG is extremely low. These data, therefore, challenge current practice and mandate a radical review of evidence and guidelines.
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A. Ross Naylor (2010) conducted a review in Concurrent carotid and cardiac disease. Coronary artery bypass grafting (CABG) plus staged or synchronous carotid endarterectomy (CEA) or carotid artery stenting (CAS) vs. Isolated CABG was evaluated on Procedural stroke or death. Coronary artery bypass grafting combined with carotid endarterectomy or stenting is associated with a 9% risk of procedural stroke or death, questioning its benefit in asymptomatic patients.
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