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413

IS COMBINED CAROTID ENDARTERECTOMY AND CABG JUSTIFIABLE IN PATIENTS WITH ASYMPTOMATIC CAROTID STENOSIS?

MC Moon, DH Freed, ML Brown, EA Pascoe, G Louridas

Winnipeg, Manitoba

INTRODUCTION: Coronary artery bypass grafting (CABG) surgery is one of the commonly performed major operations in North America. The potentially major complications of this procedure include stroke and death. Although the incidence of stroke is low, however the risk is intuitively increased in patients with known carotid disease. In an attempt to decrease the risk of stroke in patients with carotid stenosis undergoing CABG surgery, combined carotid endarterectomy (CEA) and CABG surgery has been advocated.

METHODS: A retrospective chart review and analysis of the Society of Thoracic Surgeons (STS) database was performed. The STS database was interrogated for the presence of symptomatic or asymptomatic carotid disease (>75% stenosis), post-operative permanent cerebrovascular accident (CVA), and operative mortality in patients undergoing isolated CABG or CABG+CEA.

RESULTS: Between Jan 1, 1998 and June 30, 2003, 4252 patients were identified as having received isolated CABG surgery, and 56 patients had combined CEA-CABG surgery. In the isolated CABG group the incidence of stroke was 2.02% and death was 2.59%. In the patients undergoing isolated CABG surgery with no known carotid disease (n = 3619) the incidence of permanent CVA was 1.58% and operative mortality was 2.29%. In patients undergoing isolated CABG surgery with known asymptomatic carotid disease (stenosis > 75%, n= 197) the incidence of permanent CVA was 3.05% (6/197) and operative mortality was also 3.05% (6/192). In those patients with symptomatic carotid stenosis undergoing isolated CABG surgery (n=29) the incidence of permanent CVA was 6.90% (2/29) and operative mortality was 6.90% (2/29). In patients having combined CEA-CABG the incidence of stroke was 5.36% (3/56) and mortality was 7.14 (4/56).

CONCLUSIONS: The incidence of CVA in patients undergoing combined CEA-CABG surgery is equivalent to those with asymptomatic patients undergoing isolated CABG, but lower than that of patients with symptomatic carotid stenosis undergoing isolated CABG surgery. Combined CEA-CABG surgery should be reserved for those patients who have symptomatic carotid stenosis and require coronary revascularization.

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