Combining Cardiac Surgery and surgery for carotid stenosis is not effective in the prevention of Stroke.
A new report, published in the September 2009 issue of Archives of Neurology. showed that stroke rates were significantly higher among patients who received combined endarterectomy and cardiac surgery.
As a result, physicians at Lehigh Valley Hospital and Health Network, Allentown, PA no longer combine prophylactic carotid endarterectomy and cardiac surgery at their institution.
In this study, 4335 patients undergoing CABG, aortic valve replacement, or both between July 1, 2001 and December 31, 2006 were examined .
Surgical morbidity/mortality was under 3%.Stroke was detected in 1.8% of patients undergoing cardiac surgery on the same admission. However, 76.3% occurred without significant carotid stenosis. In 94.7% of patients, stroke occurred without direct correlation to significant carotid stenosis.
Combining carotid and cardiac surgery increased the risk for postoperative stroke over that faced by patients with a similar degree of carotid stenosis but who underwent only the cardiac operation.
Postoperative stroke risk for combined carotid endarterectomy and CABG vs CABG alone in patients with comparable carotid stenosis:
End point |
CEA+CABG (%) |
CABG alone (%) |
p |
Postoperative stroke |
15.1 |
0 |
0.004 |
In an editorial by Dr Louis R Caplan (Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA) it was pointed out that 95% (72 of 76 of patients with post-operative stroke) had strokes not related to carotid artery disease. Instead, studies have shown that the major causes of stroke after CABG originate as emboli from the heart and aorta.
Sources
- Li Y, Walicki D, Mathiesen C, et al. Strokes after cardiac surgery and relationship to carotid stenosis. Arch Neurol 2009; 66:1091-1096.
- Caplan LR. Translating what is known about neurological complications of coronary artery bypass graft surgery into action. Arch Neurol 2009; 66:1062-1-54.