Register
Forgot your password?

Long-term results of coronary bypass grafting in patients with severe carotid stenosis depending on the stage of carotid endarterectomy

Authors: Sheykina N.A., Keren M.A., Sigaev I.Yu., Papitashvili V.G., Chshieva I.V., Volkovskaya I.V., Avakova S.A., Zavalikhina T.V.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-2-225-238

For citation: Sheykina N.A., Keren M.A., Sigaev I.Yu., Papitashvili V.G., Chshieva I.V., Volkovskaya I.V., Avakova S.A., Zavalikhina T.V. Long-term results of coronary bypass grafting in patients with severe carotid stenosis depending on the stage of carotid endarterectomy. Creative Cardiology. 2024; 18 (2): 225–238 (in Russ.). DOI: 10.24022/1997-3187-2024-18-2-225-238

Received / Accepted:  24.03.2024 / 02.05.2024

Keywords: coronary artery bypass grafting carotid endarterectomy asymptomatic carotid stenosis staged coronary artery bypass grafting and carotid endarterectomy



Subscribe 🔒

 

Abstract

Objective. To compare immediate and long-term outcomes in patients with combined asymptomatic carotid stenosis and coronary artery disease who underwent coronary artery bypass grafting (CABG) depending on the subsequent performance of carotid endarterectomy (CEA).

Material and methods. The study included 184 patients with combined coronary artery disease and unilateral asymptomatic stenosis of the internal carotid arteries of 70–99%, for whom the medical council determined indications for staged revascularization in the sequence: CABG (1st stage) and unilateral CEA (2nd stage). Two observation groups were formed: group 1 – patients who underwent CABG as the first stage, unilateral CEA as the 2nd stage (n=86); group 2 – patients who underwent only 1 stage – isolated CABG; the CEA stage was not implemented (n=98). In the first part of the study, the immediate results after CABG followed by staged CEA and without CEA were assessed. In the second part of the study, we assessed the frequency of adverse clinical outcomes in the long-term period up to 9 years after the interventions (on average 6 years). Study endpoints: death from all causes, non-fatal cerebrovascular accident or transient ischemic attack (stroke/TIA), non-fatal myocardial infarction (MI), major adverse coronary events (MACE), including death, non-fatal stroke/TIA, not fatal MI.

Results. In the hospital postoperative period, there were no statistically significant differences in the number of deaths from all causes (p=1.000), non-fatal MI (p=0.217), non-fatal stroke (p=0.467) and MACE (p=0.476). The long-term prognosis of the group of patients who underwent staged CABG and CEAE did not differ significantly from the group of patients who had damage to the coronary and carotid arteries, but underwent only CABG in terms of total mortality (p=0.902), incidence of MI (p=0.974), and incidence of stroke/TIA (p=0.458) and MACE (p=0.704).

Conclusion. Subsequent (2-nd stage) implementation of CEAE did not have a statistically significant effect on hospital complications and long-term outcomes after CABG (death, stroke, IM, MACE) in patients with asymptomatic carotid stenosis.

References

  1. Zivkovic I., Vukovic P., Milacic P., Milicic M., Sagic D., Ilijevski N. et al. Midterm results after simultaneous carotid artery stenting and cardiac surgery. Ann. Thorac. Surg. 2020; 110 (5): 1557–1563. DOI: 10.1016/j.athoracsur.2020.02.051
  2. Song P., Fang Z., Wang H., Cai Y., Rahimi K., Zhu Y. et al. ‘Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, metaanalysis, and modelling study’. The Lancet Global Health. 2020; 8 (5): e721–e729. DOI: 10.1016/S2214-109X(20)30117-0
  3. Roger V.L., Go A.S., Lloyd-Jones D.M., Adams R.J., Berry J.D., Brown T.M. et al. American Heart Association statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics 2011 update: a report from the American Heart Association. Circulation. 2011; 123 (4): e18–e209. DOI: 10.1161/CIR.0b013e3182009701
  4. Birchley D., Villaquiran J., Akowuah E., Lewis T., Ashley S. Staged carotid endarterectomy under local anaesthetic in patients requiring cardiac surgery. Ann. R. Coll. Surg. Engl. 2010; 92 (5): 373–378. DOI: 10.1308/003588410X12628812459850
  5. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases., in collaboration with the European society for vascular surgery (ESVC). Russian Journal of Cardiology. 2018; 8: 164–221 (in Russ.). DOI: 10.15829/1560-4071-2018-8-164-221
  6. 2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal of Cardiology. 2019; 8: 151–226 (in Russ.). DOI: 10.15829/1560-4071-2019-8-151-226
  7. Naylor R., Rantner B., Ancetti S., de Borst G.J., De Carlo M., Halliday A. et al. European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur. J. Vasc. Endovasc. Surg. 2023; 65 (1): 7–111. DOI: 10.1016/j.ejvs.2022.04.011
  8. AbuRahma A.F., Avgerinos E., Chang R.W., Darling R.C., Duncan A.A., Forbes T.L. et al. Society for Vascular Surgery Clinical Practice Guidelines for management of extracranial cerebrovascular disease. J. Vasc. Surg. 2022; 75 (1S): 4S–22S. DOI: 10.1016/j.jvs.2021.04.073
  9. Bockeria L.A., Sigaev I.Yu., Darvish N.A., Ozolinsh A.A., Eseneev M.F., Mollaev E.B. et al. Treatment tactics for patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries. S.S. Korsakov Journal of Neurology and Psychiatry. 2016; 116 (2): 22–28 (in Russ.). DOI: 10.17116/jnevro20161162122-28
  10. Naylor A.R. Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease? J. Cardiovasc. Surg. (Torino). 2009; 50 (1): 71–81. PMID: 19179993
  11. Sigaev I.Yu., Kudashev I.F., Keren M.A., Kazaryan A.V., Starostin M.V., Morchadze B.D. Determinations of the optimal surgical treatment simultaneous operations perform of carotid endarterectomy and coronary artery bypass grafting in the aspect of reducing the incidence of neurological complications. Clinical Physiology of Regional Circulation. 2017; 14 (1): 31–38 (in Russ.). DOI: 10.24022/1814-6910-2017-14-1-31-38
  12. Darvish N.A.M.A., Shogenov M.A., Mamalyga M.L., Eseneev M.F., Alshibaya M.D. Immediate results of simultaneous and stage operations on the coronary and carotid arteries. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2023; 3 (24): 185–192 (in Russ.). DOI: 10.24022/1810-0694-2023-24-3-185-192
  13. Klarin D., Patel V., Zhang S., Xian Y., Kosinski A., Yeokun B. et al. Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates. J. Vasc. Surg. 2020; 72: 589–596. DOI: 10.1016/j.jvs.2019.10.072
  14. Naylor A.R., Cuffe R.L., Rothwell P.M., Bell P.R. A systematic review of outcomes following staged and synchronous carotid endarterectomy and coronary artery bypass. Eur. J. Vasc. Endovasc. Surg. 2003; 25 (5): 380–389. DOI: 10.1053/ejvs.2002.1895
  15. Ashrafi M., Ball S., Ali A., Zeynali I., Perricone V. Carotid endarterectomy for critical stenosis prior to cardiac surgery: Should it be done? A retrospective cohort study. Int. J. Surg. 2016; 26: 53–57. DOI: 10.1016/j.ijsu.2015.12.067
  16. Tsukagoshi J., Yokoyama Y., Fujisaki T., Takagi H., Shirasu T., Kuno T. Systematic review and meta-analysis of the treatment strategies for coronary artery bypass graft patients with concomitant carotid artery atherosclerotic disease. J. Vasc. Surg. 2023; 78 (4): 1083–1094.e8. DOI: 10.1016/j.jvs.2023.04.043
  17. Hess N.R., Killic A., Serna-Gallegos D.R., Navid F., Wang Y., Thoma F., Sultan I. Effect of untreated carotid artery stenosis at the time of isolated coronary artery bypass grafting. JTCVS Open. 2021; 7: 182–190. DOI: 10.1016/j.xjon.2021.07.001
  18. Hadar N., Raman G., Moorthy D., O’Donnell T.F., Thaler D.E., Feldmann E. et al. Asymptomatic carotid artery stenosis treated with medical therapy alone: temporal trends and implications for risk assessment and the design of future studies. Cerebrovasc. Dis. 2014; 38 (3): 163–173. DOI: 10.1159/000365206
  19. Walker M.D., Marler J.R., Goldstein M. et al. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273 (18): 1421–1428. DOI: 10.1001/jama.1995.03520420037035
  20. Halliday A., Harrison M., Hayter E., Kong X., Mansfield A., Marro J. et al. Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010; 376 (9746): 1074–1084. DOI: 10.1016/S0140-6736 (10)61197-X
  21. Haywood N.S., Ratcliffe S.J., Zheng X., Mao J., Farivar B.S., Tracci M.C. et al. Operative and long-term outcomes of combined and staged carotid endarterectomy and coronary bypass. J. Vasc. Surg. 2023; 77 (5): 1424–1433.e1. DOI: 10.1016/j.jvs.2023.01.015
  22. Golukhova E., Sigaev I., Keren M., Slivneva I., Berdibekov B., Sheikina N. et al. Early and long-term results of simultaneous and staged revascularization of coronary and carotid arteries. Pathophysiology. 2024; 31: 210–224. DOI: 10.3390/pathophysiology31020017
  23. Rajaei S., Dabbagh A. Risk factors for postoperative respiratory mortality and morbidity in patients undergoing coronary artery bypass grafting. Anesth. Pain. Med. 2012; 2 (2): 60–65. DOI: 10.5812/aapm.5228
  24. Herder M., Johnsen S.H., Arntzen K.A., Mathiesen E.B. Risk factors for progression of carotid intima-media thickness and total plaque area: a 13-year follow-up study: the Tromsø Study. Stroke. 2012; 43 (7): 1818–1823. DOI: 10.1161/STROKEAHA.111.646596
  25. Shinton R., Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989; 298 (6676): 789–794. DOI: 10.1136/bmj.298.6676.789

About Authors

  • Nina A. Sheykina, Cardiologist; ORCID
  • Milena A. Keren, Dr. Med. Sci., Senior Researcher; ORCID
  • Igor Yu. Sigaev, Dr. Med. Sci., Professor, Head of Department; ORCID
  • Vasil G. Papitashvili, Cand. Med. Sci., Head of Department; ORCID
  • Inna V. Chshieva, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Irina V. Volkovskaya, Cand. Med. Sci., Head of Department; ORCID
  • Susanna A. Avakova, Cand. Med. Sci., Head of Department; ORCID
  • Tatyana V. Zavalikhina, Cand. Med. Sci., Chief Physician; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by