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 REVIEW ARTICLE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 57--64

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


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

Correspondence Address:
Dr. Parthasarathy D Thirumala
Center for Clinical Neurophysiology, Department of Neurological Surgery, UPMC Presbyterian-Suite B-400, 200 Lothrop Street, Pittsburgh, Pennsylvania - 15213
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222849

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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.






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