Paul J. Foley1, Grace J. Wang1, Edward Y. Woo1, Jeffrey P. Carpenter2, Michael A. Acker1, Joseph Woo1, Ronald M. Fairman1, Benjamin M. Jackson1
1Surgery, University of Pennsylvania, Philadelphia, PA; 2Robert Wood Johnson Medical School, Camden, NJ.
OBJECTIVES: To examine perioperative stroke and death rates for 2 methods of carotid artery revascularization, angioplasty/stenting (CAS) and endarterectomy (CEA), in patients undergoing cardiac surgery.
METHODS: Patients undergoing carotid revascularization prior to or simultaneous with a cardiac surgical procedure at a university hospital between January 2003 and October 2011 were identified. Medical records were retrospectively reviewed for demographics, comorbidities (including hypertension, diabetes, chronic renal insufficiency, COPD, and CHF), type of carotid revascularization, and outcomes. Stroke, death, and their combined endpoint (CE) were defined as the primary outcomes. Comorbidities and outcomes were compared between groups using Fisher Exact Tests.
RESULTS: Fifty-two CEAs, 28 CASs and 6 diagnostic carotid arteriograms (DCA) were performed in patients undergoing cardiac surgery, either in combination (48 CEAs), the same day (1 CAS), or preoperatively (4 CEAs, 27 CASs, 6 DCAs). There were no statistically significant differences between the CAS and CEA groups with respect to comorbidities. Compared to patients undergoing CAS, those undergoing CEA had lower rates of stroke (1.9% vs. 3.6%, p=1), death (5.8% vs. 10.7%, p=.65), and the CE (7.7% vs. 14.3%, p=.44), but none of these differences reached statistical significance. Similarly, if those undergoing DCA were considered separately or together with the CAS group, no significant difference in primary outcomes was evident. Four patients (7.7%) had procedure-specific complications in the CEA group (2 CN palsies; 2 neck hematomas). There were no access site pseudoaneurysms in the CAS/DCA patients.
CONCLUSIONS: Both CEA and CAS are viable options for carotid revascularization prior to heart surgery. Though a larger experience might reveal statistically-significant differences in outcomes, surgeon preference (and willingness to perform cardiac surgery on clopidogrel) may determine preferred strategy.
AUTHOR DISCLOSURES: M. A. Acker, Nothing to disclose; J. P. Carpenter, Nothing to disclose; R. M. Fairman, Nothing to disclose; P. J. Foley, Nothing to disclose; B. M. Jackson, Nothing to disclose; G. J. Wang, Nothing to disclose; E. Y. Woo, Nothing to disclose; J. Woo, Nothing to disclose.
Posted April 2012