Among patients undergoing evaluation for coronary artery bypass surgery, stroke neurologists are frequently consulted when the patient also has severe carotid artery stenosis (blockage of an artery that supplies blood to the brain).
In a small number of these cases, a carotid endarterectomy is performed at the same time as the bypass surgery, with the assumption that combining the procedures in a single surgical event may decrease subsequent risk of stroke or death. While combining these procedures has become more routine, a recent Canadian study, published in the April 26 issue of Neurology, suggests there is little evidence to demonstrate that this practice reduces the risk of stroke or death. Neurology is the scientific journal of the American Academy of Neurology.
Coronary artery bypass graft (CABG) surgery is a common major operation. CABG involves creating a detour or “bypass” around the blocked part of a coronary artery to restore the blood supply to the heart muscle. Carotid endarterectomy (CEA) is another relatively common operation that removes plaque from the walls of one or both arteries in the neck that supply oxygenated blood to the brain. There are several factors that may influence the outcomes of combining these surgical procedures, the most likely of which is the severity of vascular disease among these patients. Other factors include unstable angina, myocardial infarction or arrhythmia, previous stroke, and the skill and experience of the surgeon.
Although there has been an increase in the combined CEA-CABG procedure, the actual benefits to patients are not yet clear. “We sought to explore the use of these combined procedures in Canada, to evaluate its utilization over time, and to assess outcomes,” said study author Michael D. Hill, MD, MSc, of the University of Calgary in Alberta.