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Neurol India. 2018 Jan-Feb;66(1):57-64. doi: 10.4103/0028-3886.222849.

Perioperative strokes following combined coronary artery bypass grafting and carotid endarterectomy: A nationwide perspective.

Author information

1
Center for Clinical Neurophysiology, Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
2
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
3
Center for Clinical Neurophysiology, Department of Neurological Surgery, University of Pittsburgh; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

BACKGROUND:

To assess the risk of perioperative stroke on in-hospital morbidity and mortality following combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA).

MATERIALS AND METHODS:

Data from the National Inpatient Sample (NIS) database for all patients who underwent CABG with CEA were identified using ICD-9 codes. Combined procedures were identified as CEA and CABG procedures that happened on the same day. Various preoperative and perioperative risk factors and their association with in-hospital mortality and morbidity were studied.

RESULTS:

A total of 8457 patients underwent combined CABG and CEA from 1999 to 2011. The average age of the patient population was 69.98 years. A total of 6.17% (n = 521) of the patients developed perioperative strokes following combined CABG and CEA. An in-hospital mortality of 4.96% and morbidity of 66.35% was observed in the patient cohort. Patients with perioperative strokes showed a mortality of 19% and a morbidity of 89.34%. Other notable risk factors for in-hospital mortality and morbidity were heart failure, paralysis, renal failure, coagulopathy, weight loss and fluid and electrolyte disturbances, and postoperative myocardial infarction.

CONCLUSION:

A strong association was found to exist between perioperative stroke and in-hospital mortality and morbidity after combined CABG and CEA. CEA procedures are thought to mitigate the high stroke rate of 3-5% post-CABG, but our study found that combined procedures exhibit a similar stroke risk undercutting their effectiveness. Further investigative studies on combined CABG+CEA are needed to assess risk-stratification for better patient selection and examine other preventative strategies to minimize the risk of ischemic strokes.

PMID:
29322961
DOI:
10.4103/0028-3886.222849
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