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Comparison of long-term outcomes of three surgical strategies in patients with asymptomatic carotid stenosis referred for coronary artery bypass grafting

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

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

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2025-19-3-329-339

For citation: Sheykina N.A., Keren M.A., Zavalikhina T.V., Sigaev I.Yu., Arakelyan V.S., Papitashvili V.G., Chshieva I.V., Volkovskaya I.V., Avakova S.A. Comparison of long-term outcomes of three surgical strategies in patients with asymptomatic carotid stenosis referred for coronary artery bypass grafting. Creative Cardiology. 2025; 19 (3): 329–339 (in Russ.). DOI: 10.24022/1997-3187-2025-19-3-329-339

Received / Accepted:  26.05.2025 / 17.06.2025

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



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Abstract

Objective. Evaluation the impact of 3 surgical strategies (simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), staged CABG and CEA, and isolated CABG) on the incidence of late stroke and overall mortality in patients with unilateral asymptomatic carotid stenosis referred for CABG.

Material and methods. The retrospective study included 290 patients with combined coronary artery disease and unilateral asymptomatic carotid stenosis of 70–99%, who, by decision of a multidisciplinary council, were determined to have indications for CABG in combination with CEA by means of a simultaneous (under conditions of one anesthesia) or 2-stage intervention (CABG was performed at the first stage, then CEA). The patients were divided into groups according to the interventions performed. A separate group included patients with indications for a staged intervention (first CABG, then CEA), however, who underwent only 1 stage of treatment (only CABG was performed, and CEA was not performed). The follow-up period was up to 9 years after the interventions, and the median follow-up was 6.6 years [5.1–9.4]. Study endpoints – death from any cause, non-fatal stroke, combined endpoint: death from any cause/non-fatal stroke.

Results. CEA among the studied patients did not lead to an improvement in the long-term prognosis. None of the surgical strategies had advantages in terms of reducing overall death, the incidence of stroke or the combined point (death/stroke). At the same time, patients after simultaneous interventions had a worse outcome for combined point (p=0.005), but not for isolated points.

Conclusion. The results of the study do not confirm the long-term benefits of any of the surgical strategies (simultaneous CABG and CEA, staged CABG and CEA, and isolated CABG) in terms of reducing the incidence of death, stroke and combined event frequency (death/stroke) in patients with carotid stenosis referred for CABG. Patients after simultaneous CABG and CEA have the worst long-term outcome.

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About Authors

  • Nina A. Sheykina, Cardiologist; ORCID
  • Milena A. Keren, Dr. Med. Sci., Senior Researcher; ORCID
  • Tatyana V. Zavalikhina, Cand. Med. Sci., Chief Physician of the Institute of Coronary and Vascular Surgery (ICVS); ORCID
  • Igor Yu. Sigaev, Dr. Med. Sci., Professor, Head of the Department of Surgery of Combined Diseases of the Coronary and Main Arteries, Acting Director of ICVS; ORCID
  • Valeriy S. Arakelyan, Dr. Med. Sci., Professor, Head of the Department of Arterial Pathology Surgery; ORCID
  • Vasil G. Papitashvili, Dr. Med. Sci., Head of the Cardiac Surgery Department No. 5; ORCID
  • Inna V. Chshieva, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Irina V. Volkovskaya, Cand. Med. Sci., Head of the Consultative and Diagnostic Center of ICVS; ORCID
  • Susanna A. Avakova, Cand. Med. Sci., Head of the Consultative and Diagnostic Center of Burakovsky Institute of Cardiac Surgery; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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