Comparative Results of Combined Coronary Artery Bypass Grafting and Carotid Endarterectomy versus Staged Operation

Yang Jin Park; Dong-Ik Kim; Young Nam Roh; Wook Sung Kim; Young Tak Lee; Gyeong-Moon Kim; Duk-Kyung Kim; Young-Wook Kim

doi:10.4174/jkss.2011.80.1.61

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Park, Kim, Roh, Kim, Lee, Kim, Kim, and Kim: Comparative Results of Combined Coronary Artery Bypass Grafting and Carotid Endarterectomy versus Staged Operation

Original Article

Journal of Korean Spine Surg 2011;80(1):61-66.

Published online: 4 February 2011

DOI: https://doi.org/10.4174/jkss.2011.80.1.61

Comparative Results of Combined Coronary Artery Bypass Grafting and Carotid Endarterectomy versus Staged Operation

Yang Jin Park, M.D., Dong-Ik Kim, M.D., Young Nam Roh, M.D., Wook Sung Kim, M.D.¹, Young Tak Lee, M.D.¹, Gyeong-Moon Kim, M.D.², Duk-Kyung Kim, M.D.³, Young-Wook Kim, M.D.

Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea

¹Department of Thoracic and Cardiovscular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

책임저자: 김영욱, 서울시 강남구 일원동 50번지? 135-710, 성균관대학교 의과대학 삼성서울병원 혈관외과 Tel: 02-3410-3461, Fax: 02-3410-0040 E-mail: ywkim@skku.edu

Received 27 October 2010 Accepted 13 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Between combined and staged operations of carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) for patients with concurrent coronary and carotid disease, each treatment strategy has its own advantages and disadvantages. We attempted to compare early surgical results between the two operations.

Methods

We retrospectively reviewed medical records of 71 patients who underwent either combined CEA & CABG (n=37) or staged CABG & CEA (n=34) in a single institute between January 2001 and March 2010. After comparing patients' demographics and preoperative neurologic and cardiac status, we compared early (<1 month) postoperative cardiac or neurologic complications and surgical mortality between the 2 groups.

Results

There was no significant difference in patients' demographics and indications for operation the between 2 groups. There were 2 (5.4%) cases of postoperative stroke in combined groups and 1 (2.9%) in staged group. However, there was no myocardial infarction or death. In staged operation group, during the interval time between the two operations, 5 cases (14.7%) of stroke developed, of which, all patients recovered without any sequelae by anticoagulation.

Conclusion

After experiencing low postoperative cardiac or neurologic morbidity or mortality after combined CABG and CEA, we conclude that combined CABG and CEA was a safe and feasible treatment option for patients with neurologic symptoms and in stable cardiac status. In the staged operation group of patients, we observed development of neurologic events during the interval period between CABG and CEA. To attain optimal treatment strategy in asymptomatic patients, further prospective study would be required.

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Keywords: Endarterectomy, Carotid artery, Coronary artery bypass

References

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Table 1.

Patients demographics

	Combined (n=37)	Staged (n=34)	P
Male	31 (84%)	29 (85%)	0.861
Age (mean, year)	68.7±6.4	66.6±8.2	0.231
Smoking history	12 (32%)	22 (65%)	0.007
Hypertension	29 (78%)	21 (62%)	0.125
Diabetes mellitus	22 (60%)	15 (44%)	0.196
Atrial fibrillation	1 (3%)	2 (6%)	0.604
CRF^*	3 (8%)	2 (6%)	1.000
COPD^†	3 (8%)	4 (12%)	0.699

^* CRF= chronic renal failure;

^† COPD = chronic obstructive pulmonary disease.

Table 2.

Preoperative cardiac profiles and coronary artery bypass grafting (CABG) procedures

	Combined (n=37)	Staged (n=34)	P
LV^* ejection fraction	57±13.3%	56.3±9.9%	0.335
Clinical feature of CAD^†			0.879
Stable angina	22 (61%)	22 (67%)
Unstable angina ^‡	10 (28%)	7 (21%)
Acute MI^‡	4 (11%)	4 (12%)
No. of diseased coronary arteries
1 or 2 vessels	8 (22%)	3 (9%)	0.137
3 vessels	29 (78%)	31 (91%)
CABG procedures
Cardiac arrest	3 (8%)	4 (13%)	0.696
OPCABG^§	33 (89%)	28 (88%)	1.000
Aorta clamping	9 (24%)	4 (13%)	0.210

^* LV = left ventricle;

^† CAD = coronary artery disease;

^‡ MI = myocardial infarction;

^§ OPCABG = off-pump coronary artery bypass grafting.

Table 3.

Clinical features of carotid stenosis (CS)

	Combined (n=37)	Staged (n=34)	P
Ipsilateral CS^*＞70%	35 (94.6%)	30 (88.2%)	0.417
Contralateral CS＞70%	15 (40.5%)	8 (23.5%)	0.126
Presence of plaque ulcer	6 (16.2%)	2 (5.9%)	0.264
Any previous neurologic symptom	12 (32.4%)	5 (14.7%)	0.082
Neurologic symptom within 6 months	4 (10.8%)	1 (2.9%)	0.359
No neurologic symptom	33 (89.2%)	33 (97.1%)
Ipsilateral CS＞70% with contralateral carotid occlusion	9 (27.3%)	1 (3.0%)	0.006
Bilateral CS＞70%	15 (45.5%)	7 (21.2%)	0.037

^* CS = carotid stenosis.

Table 4.

Postoperative morbidity and mortality

	Combined (n=37)	Staged (n=34)	P
Duration of follow-up (mean, mo)	53.3±27.3	64.1±32.9	0.134
Operative morbidity
General
Postoperative bleeding	0	3 (8.8%)
CEA site	0	2 (5.9%)
CABG site	0	1 (2.9%)
Neurologic	2 (5.4%)	6 (17.6%)	0.141
Stroke^* ≤1 month	2 (5.4%)	1 (2.9%)	1.000
Stroke^* during the waiting time for CEA^† after CABG^‡	NA	5 (14.7%)
Cardiac
Acute myocardial infarction	0	0
Arrhythmia	0	0
Operative mortality	0	0

^* All minor or reversible stroke;

^† CEA = carotid endarterectomy;

^‡ CABG = coronary artery bypass grafting.

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