ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of degree of stenosis and surgical timing on stroke and mortality in patients with carotid artery stenosis who are undergoing coronary bypass grafting: Retrospective study
Ünsal Vural, Mehmet Kızılay, Ahmet Yavuz Balcı, Zeynep Aslan, Ferruh Elbir
Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2015.10914
Background: This study aims to compare patient groups who underwent carotid endarterectomy with concurrent and primary coronary artery bypass grafting (CABG) in terms of stroke and mortality in an attempt to detect appropriate surgical timing.

Methods: The study included 205 patients (143 males, 62 females; mean age 64.7±7.6 years; range 48 to 78 years) with carotid stenosis who underwent CABG between June 2010 and June 2014. All of the patients were asymptomatic. Patients were grouped according to carotid stenosis as ≤50% with mild stenosis (group 1; n=83), 50-70% with medium stenosis (group 2; n=43), 70-99% with critical stenosis who underwent primary CABG (group 3; n=23), and 70-99% with critical stenosis who underwent concurrent intervention (group 4; n=56). Groups with mild and medium stenosis were only performed CABG. Groups were analyzed in terms of clinical features, cardiopulmonary bypass duration and number, hospital stay duration, transient ischemic attack, stroke, and mortality.

Results: Patients’ demographic features were statistically similar (p>0.05). Difference between the groups in terms of stroke was significant (p=0.028). Maximal difference was between group 3 (26%; n=6) and group 1 (5%; n=1). Increase in carotid stenosis showed a relationship by a rate of 8% with stroke (p=0.048). Stroke affected hospital and intensive care stay durations (p<0.01). Coronary artery bypass grafting duration and graft number did not affect stroke (p=0.443, p=0.324). Stroke and mortality showed a relationship by 29% (p<0.001). While the highest mortality was observed in group 4, the difference was not significant (p=0.548). Mortality affected hospital stay duration significantly (p=0.001; p=0.001). No significant relationship was detected in groups with critical stenosis in terms of stroke, mortality and transient ischemic attack (p=0.215; p=0.853; p=0.769).

Conclusion: Our study indicates that while the degree of carotid stenosis increases, rate of stroke increases; and concurrent operations in critical stenosis are effective and safe. Intervention to critical stenosis decreased rate of stroke by 12%. Although not convenient, the advantage provided by concurrent interventions in stroke and cost should be taken into consideration.

Keywords : Carotid endarterectomy; carotid stenosis; combined interventions; mortality; postoperative analysis; primary coronary bypass; stroke
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