Abstract 5498: The Cumulative Risk of Stroke and Death From Carotid Endarterectomy Followed by Coronary Artery Bypass Surgery in Patients With Concomitant Critical Coronary and Carotid Stenosis

Abstract

Background: Coexisting critical coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) and critical carotid stenosis requiring carotid endarterectomy (CEA) is becoming increasingly common. The reported incidence of stroke and death as perioperative complications of CABG range from 1.1 to 3.8% and 1 to 3%, respectively. The cumulative risk of stroke and death in patients undergoing a CEA followed by CABG in a high-risk subset, as described above, is not well defined. Objective: To determine the cumulative risk of in-hospital stroke and death when CEA precedes CABG, and also if a preceding history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) increases the risk of in-hospital stroke and death. Methods: Using ICD-9 codes we identified 114 consecutive patients in our institution who were scheduled to undergo a staged CEA followed by CABG. Records of all patients were reviewed to identify comorbidities and confirm the incidence of all-cause mortality and stroke. The patients were further divided into two groups based on the presence or absence of a prior history of TIA/CVA. Results: Three patients died after CEA, 111 patients proceeded to CABG. Conclusion: Cumulative risk of stroke and death from both procedures should be considered in these patients. Despite CEA procedure aimed at reducing the risk of perioperative stroke from CABG, 3.6% of the patients in our study had a nonfatal CVA after CABG. Patients with a prior history of TIA/CVA did not show a significant increase in periprocedural risk of stroke and death. Table 1 Cumulative risk of nonfatal CVA and Death Table 2 Risk of nonfatal CVA and Death based on a history of TIA/CVA