There are several factors that may influence the outcomes of combining coronary artery bypass graft (CABG) and carotid endarterectomy (CEA), the most likely of which is the severity of vascular disease among these patients.

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 utilisation over time, and to assess outcomes,” said study author Michael D. Hill, MD, MSc, of the University of Calgary in Alberta.

Of the 131,762 studied patients underwent CABG, and 669 (0.51 percent) combined CEA-CABG. The in-hospital death rate was 4.9 percent, and the post-operative stroke rate was 8.5 percent among patients who had the combined procedure, compared to 3.3 percent and 1.8 percent among patients who had CABG alone.

After adjustment, the risk of death was not statistically different between the two groups, but an excess risk of stroke remained in the combined CEA-CABG group of 6.8 percent compared to 1.8 percent in the CABG group.

In an accompanying Neurology editorial, Patrick Pullicino, MD, of the University of Medicine and Dentistry of New Jersey, affirms the need for continuing study. Pullicino noted outcomes of the recent Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE), that have shown carotid angioplasty and stenting, pre-operative alternatives to CABG surgery, can be performed with a low combined stroke and death rate in high-risk patients with carotid stenosis.

"As a result of the SAPPHIRE study, pre-CABG carotid angioplasty with or without stenting has replaced CEA-CABG at several centers in the U.S., leaving the burden on surgeons who perform CEA-CABG to show that it can be performed with acceptable risks,” noted Pullicino.; Source: American Academy of Neurology (AAN)