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Risk of death increases with combined heart and stroke prevention surgery

Patients who undergo combined heart bypass surgery and carotid endarterectomy, the most commonly used stroke prevention surgery, significantly increase their chances of death or stroke, according to a study published in the January 16, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

The study involved the review of hospital discharge data from 657,877 patients who had been admitted to U.S. hospitals for carotid endarterectomy or coronary bypass artery surgery from 1993 to 2002.

The study found a 38 percent greater chance of death or postoperative stroke among patients with combined coronary bypass artery surgery and carotid endarterectomy compared to the risk of death or stroke from coronary artery bypass surgery alone. Carotid endarterectomy is the surgical removal of harmful plaque build-up in the carotid arteries, the main suppliers of blood to the brain.

The underlying rationales for combining both procedures are to protect the carotid artery from blockage, or stroke, during the heart bypass surgery and to lessen the risk of stroke by having just one procedure.

"The benefit of this combined procedure is controversial," said study author Richard M. Dubinsky, MD, MPH, with the University of Kansas Medical Center in Kansas City, Kansas, and a Fellow of the American Academy of Neurology. "Given this significant increase in postoperative stroke and death, a randomized clinical trial of the combined surgery is needed to determine the benefit, if any, compared to performing the operations in separate hospitalizations."

Dubinsky says the increase in death or stroke could be due to the degree of narrowing of carotid arteries, the patient's history of previous stroke, or other factors that could not be identified from the data. He says those are two areas that must be matched in any future clinical trials.

In addition, Dubinsky says this is the first study to show that being female was slightly protective against postoperative death or stroke after the combined procedures.

Stroke affects more than 700,000 people in the United States each year. A blockage of a blood vessel is responsible for about 80 percent of strokes.

Angela Babb | EurekAlert!
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