A Comparison of Synchronous versus Staged Carotid Endarterectomy and Carotid Artery Stenting in combination with Off-pump Coronary Artery Bypass Grafting
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Authors
Ready, Christiana G.
Sanders, Kimberly
Kimberly, Caitlin
Issue Date
2023-03-24
Type
Other
Language
en_US
Keywords
Carotid artery revascularization, Off-pump coronary artery bypa , Off-pump Coronary Artery Bypass Grafting (CABG) , Perioperative Stroke Outcomes
Alternative Title
Abstract
This study aimed to analyze the impact of prophylactic carotid artery revascularization among patients scheduled to undergo offpump coronary artery bypass grafting (CABG). The following types of carotid artery revascularization were compared: synchronous carotid endarterectomy (CEA), staged CEA, synchronous carotid arterystenting (CAS), and staged CAS. Perioperative stroke was the main endpoint examined. Secondary considerations included: (1) the independent advantages conferred by off-pump CABG and (2) the indications for prophylactic carotid artery revascularization prior to cardiac surgery. A total of twenty eligible articles were critically appraised, all of which were obtained from PubMed and Cochrane databases. Overall, nearly all articles recommended scheduling the timing of carotid intervention based on the acuity of coronary artery disease (CAD). The incidence of perioperative stroke in articles combining CEA with off-pump CABG was typically lower than those evaluating CAS. However, this observation may be due to the greater quantity and quality of articles published on CEA in present time. The research also favored the use of off-pump CABG over on-pump CABG in high-risk surgical patients due to its enhanced hemodynamic stability, limited immune system activation, decreased aortic manipulation, and reduced blood loss. Notably, the threshold severity of carotid artery stenosis established as an indication for revascularization varied slightly among the articles; though, most patients with over 70% stenosis underwent carotid intervention prior to cardiac surgery. In aggregate, synchronous CEA coupled with offpump CABG appears to be a safe and efficacious option for patients with concurrent carotid and coronary artery disease in need of urgent surgical intervention. Ultimately, it is hoped that the results of this study will help clarify the clinical guidelines used to manage a growing number of patients with atherosclerotic cardiovascular disease (ASCVD).
Description
UB Rise 2023
Physician Assistant Institute
College of Health Sciences
University of Bridgeport