Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Increased risk associated with combining carotid artery, coronary artery surgeries

26.04.2005


Among patients undergoing evaluation for coronary artery bypass surgery, stroke neurologists are frequently consulted when the patient also has severe carotid artery stenosis (blockage of an artery that supplies blood to the brain). In a small number of these cases, a carotid endarterectomy is performed at the same time as the bypass surgery, with the assumption that combining the procedures in a single surgical event may decrease subsequent risk of stroke or death. While combining these procedures has become more routine, a recent Canadian study, published in the April 26 issue of Neurology, suggests there is little evidence to demonstrate that this practice reduces the risk of stroke or death. Neurology is the scientific journal of the American Academy of Neurology.



Coronary artery bypass graft (CABG) surgery is a common major operation. CABG involves creating a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. Carotid endarterectomy (CEA) is another relatively common operation that removes plaque from the walls of one or both arteries in the neck that supply oxygenated blood to the brain. There are several factors that may influence the outcomes of combining these surgical procedures, the most likely of which is the severity of vascular disease among these patients. Other factors include unstable angina, myocardial infarction or arrhythmia, previous stroke, and the skill and experience of the surgeon.

Although there has been an increase in the combined CEA-CABG procedure, the actual benefits to patients are not yet clear. "We sought to explore the use of these combined procedures in Canada, to evaluate its utilization over time, and to assess outcomes," said study author Michael D. Hill, MD, MSc, of the University of Calgary in Alberta.


Between 1992 and 2001, all patients who underwent CABG at a Canadian hospital (excluding Quebec) were studied. Of the 131,762 patients who underwent CABG, 669 (0.51 percent) underwent combined CEA-CABG. The in-hospital death rate was 4.9 percent, and the post-operative stroke rate was 8.5 percent among patients who had the combined procedure, compared to 3.3 percent and 1.8 percent among patients who had CABG alone. After adjustment, the risk of death was not statistically different between the two groups, but an excess risk of stroke remained in the combined CEA-CABG group of 6.8 percent compared to 1.8 percent in the CABG group.

"Because the stroke risk of the combined surgical procedures remained significantly higher than in the CABG procedure alone, we believe further, randomized trials are necessary to demonstrate the appropriateness of combining these procedures," concluded Hill.

In an accompanying Neurology editorial, Patrick Pullicino, MD, of the University of Medicine and Dentistry of New Jersey, affirms the need for continuing study. Pullicino noted outcomes of the recent Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE), that have shown carotid angioplasty and stenting, pre-operative alternatives to CABG surgery, can be performed with a low combined stroke and death rate in high-risk patients with carotid stenosis.

"As a result of the SAPPHIRE study, pre-CABG carotid angioplasty with or without stenting has replaced CEA-CABG at several centers in the U.S., leaving the burden on surgeons who perform CEA-CABG to show that it can be performed with acceptable risks," noted Pullicino.

Robin Thompson | EurekAlert!
Further information:
http://www.aan.com

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Safe glide at total engine failure with ELA-inside

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded after a glide flight with an Airbus A320 in ditching on the Hudson River. All 155 people on board were saved.

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded...

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

New pop-up strategy inspired by cuts, not folds

27.02.2017 | Materials Sciences

Sandia uses confined nanoparticles to improve hydrogen storage materials performance

27.02.2017 | Interdisciplinary Research

Decoding the genome's cryptic language

27.02.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>