Our Summary
This research aimed to find out what happens to patients who have both carotid and heart disease, and who undergo two types of surgery: one to place a stent in their carotid artery (CAS), and another to bypass their coronary artery (CABG). The researchers looked at studies involving patients who underwent both surgeries either on the same day or with a delay between them.
Out of 31 studies, including 2727 patients, the researchers found that overall, about 8% of patients died or had a stroke within 30 days after their surgeries. If the two surgeries were staged (done with a delay in between), the rate was slightly higher (8.5%) compared to when they were done on the same day (5.9%). Patients who showed signs of neurological problems had worse outcomes, with a 15% rate of stroke.
The study also looked at five different ways of using antiplatelet drugs, which help prevent blood clots, before and after surgery. The results varied, with the rate of death, stroke, or heart attack ranging from 4.2% to 16% depending on the strategy used. However, there wasn’t enough information to determine the risk of bleeding complications for some strategies.
In conclusion, the research did not find evidence that having both surgeries on the same day resulted in worse outcomes than having them staged. However, patients with neurological symptoms had worse outcomes. More information is needed to determine the best way to use antiplatelet drugs in these patients.
FAQs
- What was the aim of the research on patients with both carotid and heart disease?
- What was the overall rate of death or stroke within 30 days after surgery according to the research?
- What did the study find about the use of antiplatelet drugs before and after surgery?
Doctor’s Tip
A helpful tip a doctor might tell a patient about CABG is to discuss the risks and benefits of having both carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) surgeries done on the same day versus staged with a delay. It is important to carefully consider the individual patient’s risk factors, including any neurological symptoms, and to discuss the use of antiplatelet drugs before and after surgery to prevent complications such as blood clots. Overall, the decision should be made based on the patient’s specific circumstances and in consultation with their healthcare team.
Suitable For
Patients who are typically recommended for CABG (coronary artery bypass grafting) are those who have severe coronary artery disease that cannot be managed effectively with medications or less invasive procedures. These patients may have:
- Severe blockages in multiple coronary arteries
- Left main coronary artery disease
- Severe angina (chest pain) that is not controlled with medications
- Previous heart attacks
- Diabetes
- Reduced heart function (low ejection fraction)
In addition, patients who have carotid artery disease in addition to heart disease may be recommended for both CABG and CAS (carotid artery stenting) if they have significant blockages in both arteries. These patients may have:
- Symptoms of carotid artery disease, such as transient ischemic attacks (TIAs) or strokes
- Severe blockages in the carotid artery that are causing symptoms or are at high risk of causing a stroke
Ultimately, the decision to recommend CABG or a combination of CABG and CAS depends on the individual patient’s specific medical history, symptoms, and overall health. It is important for patients to discuss their treatment options with their healthcare providers to determine the best course of action for their particular situation.
Timeline
Before CABG:
- Patient is diagnosed with coronary artery disease and undergoes various tests to determine the extent of the blockages in their arteries.
- Patient may undergo lifestyle changes, medication management, and other treatments to manage their symptoms.
- If the blockages are severe and affecting the patient’s quality of life or putting them at risk for a heart attack, the patient may be recommended for CABG surgery.
During CABG:
- Patient undergoes pre-operative evaluations and preparations, which may include blood tests, imaging tests, and consultations with various healthcare providers.
- Patient undergoes CABG surgery, during which a surgeon creates new pathways for blood to flow around the blocked arteries using grafts from other parts of the body.
- Patient is closely monitored in the hospital post-surgery for any complications or signs of infection.
After CABG:
- Patient undergoes a period of recovery in the hospital, which may include physical therapy, medication management, and monitoring of their heart function.
- Patient is discharged from the hospital and continues their recovery at home, which may include follow-up appointments with their healthcare provider, medication management, and lifestyle changes to promote heart health.
- Patient undergoes cardiac rehabilitation to improve their overall heart health and reduce the risk of future heart problems.
What to Ask Your Doctor
Some questions a patient should ask their doctor about CABG include:
- What are the potential risks and complications associated with CABG surgery?
- How long is the recovery process after CABG surgery?
- Will I need to make any lifestyle changes or follow a specific diet after CABG surgery?
- What medications will I need to take before and after CABG surgery?
- How often will I need follow-up appointments after CABG surgery?
- What symptoms should I watch out for that may indicate a problem after CABG surgery?
- Are there any restrictions on physical activity or driving after CABG surgery?
- What is the success rate of CABG surgery in patients with both carotid and heart disease?
- Are there any alternative treatments to consider instead of CABG surgery?
- How should I prepare mentally and emotionally for CABG surgery?
Reference
Authors: Paraskevas KI, Nduwayo S, Saratzis AN, Naylor AR. Journal: Eur J Vasc Endovasc Surg. 2017 Mar;53(3):309-319. doi: 10.1016/j.ejvs.2016.12.019. Epub 2017 Jan 13. PMID: 28094166