Is carotid artery stenting an alternative to simultaneous carotid endarterectomy performed for carotid artery stenosis in patients undergoing isolated coronary bypass surgery?

Abstract

Background: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. Methods: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed. Group 1 (n = 71) had coronary artery bypass surgery under general anesthesia with carotid endarterectomy followed by cardiopulmonary bypass with heart team decision. Again with heart team decision, Group 2 (n=31), patients at high-risk for carotid endarterectomy (serious cardiac disease, severe chronic obstructive pulmonary disease, superiorly located lesions), received carotid artery stents in the interventional radiology department and a month later, coronary bypass surgery was performed with cardiopulmonary bypass under elective conditions. Results: Median of patient age was 67.5 (45-83) years. Twenty-two patients (31%) in Group 1 and 19 patients (56.3%) in Group 2 had neurological symptoms, which was statistically significant (P =.004). During the early postoperative term, three patients (4.2%) in Group 1 and two patients (6.5%) in Group 2 died (P =.64). Five patients (7.0%) in Group 1 and two patients (6.5%) in Group 2 developed neurological symptoms during the early postoperative term (P >.05). Likewise, two patients (2.8%) in Group 1 and five patients (16.1%) in Group 2 developed myocardial infarction following carotid intervention (P =.03). Conclusions: In patients with significant carotid artery stenosis undergoing coronary bypass surgery with cardiopulmonary bypass, in comparison to simultaneous carotid endarterectomy with coronary bypass technique and carotid artery stenting followed with coronary bypass technique showed no difference in combined endpoint (postoperative myocardial infarction, neurological events, and mortality). With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed.