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. 2024 May;41(5):1911-1922.
doi: 10.1007/s12325-024-02805-0. Epub 2024 Mar 13.

Perioperative and Long-Term Outcomes in Patients Undergoing Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: A Single-Center Experience

Paimann Nawrozi #  1   2 , Thomas Ratschiller #  3   4 , Wolfgang Schimetta  5 , Gregor Gierlinger  4   6 , Markus Pirklbauer  7 , Hannes Müller  3   4 , Andreas Zierer  3   4
Affiliations

Perioperative and Long-Term Outcomes in Patients Undergoing Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: A Single-Center Experience

Paimann Nawrozi et al. Adv Ther. 2024 May.

Abstract

Introduction: Patients requiring coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) can be managed with staged (CEA before CABG), reverse staged (CABG before CEA) or synchronous treatment. This single-center retrospective study evaluated the outcomes in patients undergoing planned synchronous CEA and CABG.

Methods: Between 2000 and 2020 a total of 185 patients with symptomatic triple-vessel or left main coronary artery disease associated with 70-99% asymptomatic or 50-99% symptomatic uni- or bilateral internal carotid artery (ICA) stenosis underwent synchronous CEA and CABG at our institution. Study endpoints were defined as mortality, stroke and myocardial infarction at 30 days. Additionally, the composite endpoint of these events was investigated.

Results: At 30 days, mortality, stroke and myocardial infarction rates were 5.9%, 8.1% (permanent [unresolved deficit at discharge] 5.4%) and 3.8%, respectively, and the composite endpoint was reached in 13.0% of patients. Patients suffering from a stroke more frequently had a contralateral 70-99% ICA stenosis (60.0% vs. 17.3%; p < 0.001), peripheral artery disease (73.3% vs. 38.9%; p = 0.013) and prolonged cardiopulmonary bypass time (mean 119 ± 62 min vs. 84 ± 29 min; p = 0.012). Multivariate logistic regression analysis revealed the duration of cardiopulmonary bypass (odds ratio [OR] 1.024; 95% confidence interval [CI] 1.002-1.046; p = 0.034), a history of type 2 diabetes mellitus (OR 5.097; 95% CI 1.161-22.367; p = 0.031) and peripheral artery disease (OR 5.814; 95% CI 1.231-27.457; p = 0.026) as independent risk factors for reaching the composite endpoint.

Conclusion: Patients undergoing synchronous CEA and CABG face an elevated risk of perioperative cardiovascular events, particularly an increased stroke risk in patients with symptomatic and bilateral ICA stenosis. Graphical Abstract available for this article.

Keywords: Carotid endarterectomy; Coronary artery bypass grafting; Internal carotid artery stenosis; Long-term survival; Perioperative stroke.

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Conflict of interest statement

Paimann Nawrozi, Thomas Ratschiller, Wolfgang Schimetta, Gregor Gierlinger, Markus Pirklbauer, Hannes Müller and Andreas Zierer declare no conflicts of interest related to this study.

Figures

Fig. 1
Fig. 1
A Magnetic resonance imaging scan indicating the severity of the internal carotid artery stenosis, B carotid endarterectomy with intraluminal shunting prior to patch angioplasty, C diffusion-weighted imaging of a 75-year-old man with left-sided hemiparesis after on-pump synchronous treatment with endarterectomy of the left carotid artery showing multiple diffusion abnormalities scattered throughout the brain
Fig. 2
Fig. 2
Kaplan-Meier long-term survival analysis of study population compared with the survival probability of the general Austrian population matched for gender and age. CI confidence interval
Fig. 3
Fig. 3
Kaplan-Meier estimates of freedom from any cardiovascular reintervention. CI confidence interval, CV cardiovascular
See this image and copyright information in PMC

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