Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

Abstract

Carotid artery stenosis and coronary artery disease share common risk factors and often coexist in the same patient. Currently, no consensus exists regarding the optimal treatment strategy for patients with concomitant severe coronary and carotid disease. We reviewed the results of our experience performing off-pump coronary artery bypass grafting (CABG) within 24 hours of carotid endarterectomy (CEA) in this select patient population. In this single institution retrospective study we identified patients who underwent CEA followed by CABG from March 2001 to March 2012. Preoperative, intraoperative, and postoperative data were collected and analyzed. Ninety patients underwent CEA followed by off-pump CABG. The duration between CEA and CABG was 1.8±5.6 days with 80 (89%) within 24 hours. Mean age was 69±9 years, 68% male. Perioperative comorbidities included hypertension (87%), diabetes (50%), previous myocardial infarction (24%), peripheral arterial disease (20%), and strokes and transient ischemic attack (16%). Extensive aortic atherosclerosis was noted in 15 patients (17%). The average number of vessels bypassed was 3.4±1.0, and the average number of proximal vein aortotomies was 1.7±0.92. Post-CEA surgical outcomes were myocardial infarction (1%), acute embolic cerebrovascular accident (1%), left upper extremity weakness (1%), and hypoglossal nerve injury (1%). Post-CABG surgical outcomes included atrial fibrillation (34%), anemia (12%), pneumothorax (7%), and postoperative bleeding (4%). No post-CABG cerebrovascular accident was identified. Patients were discharged 7.5±3.5 days after CEA. Twenty-four hour staged CEA followed by CABG minimizes myocardial infarction post-CEA while minimizing cerebrovascular accident post-CABG in patients with concomitant severe coronary and carotid artery disease.