Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: a retrospective study.
BACKGROUND
Our retrospective single-center study aimed to evaluate the safety of the carotid endarterectomy (CEA) in comparison to patients with untreated asymptomatic carotid stenosis ≥60% before CABG.


METHODS
This single-center retrospective study included 174 patients with asymptomatic unilateral carotid stenosis treated between 2004 and 2017 with CABG. Thereof 106 patients had CEA before cardiac surgery either by a simultaneous (n = 62) or staged (n = 44) approach. Patients with untreated carotid stenosis served as control (no-CEA group; n = 68).


RESULTS
The mean stenosis grade was higher in the CEA group (CEA 83% (±1), no-CEA 71% (±1) p < 0.0001). The overall stroke rate was 5/174 (3%) and was due to a high incidence of stroke in the no-CEA group (CEA: 0/106 (0%); No-CEA 5/68 (7%) p = 0.0083). The overall mortality was 1% and comparable between the groups (CEA: 2/106 (2%); No-CEA 0/68 (0%) p = 0.5211). Stroke related mortality was not observed. The groups were similar regarding the incidence of myocardial infarction (p = 1.0), atrial fibrillation (p = 0.1931), delirium (p = 0.2106) and IMC/ICU stay (p = 0.1542). No significant difference in the subgroup analysis was found between the simultaneous and staged approach regarding the myocardial infarction (simultaneous: 1/62 (1%); staged: 1/44 (1%); p = 1.0).


CONCLUSIONS
CEA performed as a staged procedure in local anesthesia or a simultaneous procedure in general anesthesia, may reduce the stroke risk prior to CABG.
['Lescan|Mario|M|0000-0002-3124-4994', 'Andic|Mateja|M|', 'Bartos|Oana|O|', 'Schlensak|Christian|C|', 'Mustafi|Migdat|M|']
D000368:Aged D058070:Asymptomatic Diseases D016893:Carotid Stenosis D000072700:Conservative Treatment D001026:Coronary Artery Bypass D003324:Coronary Artery Disease D016894:Endarterectomy, Carotid D005260:Female D006801:Humans D008297:Male D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D020521:Stroke D013997:Time Factors D016896:Treatment Outcome
Carotid endarterectomy Carotid stenosis Cardiac surgery Staged procedure Simultaneous procedure