Long-term outcomes of synchronous carotid endarterectomy and coronary artery bypass grafting versus solely carotid endarterectomy

Abstract

Objective: To compare the effect of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with solely CEA.

Methods: During a five-year period ending December 2009, 25 consecutive patients received concomitant CEA and CABG, whereas, 62 consecutive patients underwent only CEA. They were followed at the median for 64.5 months. The Kaplan-Meier method was used to evaluate the survival rate of patients in both groups.

Results: There was no significant difference in terms of age, proportion of gender, risk factors of coronary artery disease and carotid artery stenosis. The degree of carotid artery stenosis was identical in both study groups. One patient in CEA/CABG group had 60% stenosis of carotid artery with ulcerative plaque. There was no early death in the short postoperative period. Restenosis was found on ultrasonography in 4 patients in the CEA/CABG group, and 12 patients in the CEA group; no statistical difference was found between both groups (P = 0.952). The intubation time, ICU stay, and hospital stay in CEA/CABG group were longer than in solely CEA group (P <0.001). The median duration of follow-up was 64.5 months (IQR 24-84 months). The survival rate was 88 %(22/25) in CEA/CABG group and 80.6 %(50/62) in CEA group, product-limit analysis showed that there was no significant difference in survival rates between two groups (P >0.05).

Conclusion: concomitant carotid endarterectomy and CABG can be safely performed, it could prevent stroke and would not increase the overall risk of surgery.