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Optimal management of carotid artery disease in patients undergoing coronary artery bypass
It is well-known that patients undergoing coronary artery bypass grafting (CABG) with coexisting carotid artery disease are at increased risk for perioperative stroke and death. The prevalence of carotid disease among patients undergoing CABG is 6% to 14%,1 and the risk of stroke following CABG increases from 3% for unilateral 50% to 99% stenosis to 5% for bilateral 50% to 99% stenoses and 10% for carotid occlusion.2 The risk of stroke and death are notably higher in patients with a history of transient ischemic attack (TIA)/stroke.
Source: Journal of Vascular Surgery - September 20, 2023 Category: Surgery Authors: Christopher K. Zarins Tags: Invited commentary Source Type: research

Systematic Review and Meta-Analysis of the Treatment Strategies for Coronary Artery Bypass Graft Patients with Concomitant Carotid Artery Atherosclerotic Disease
Stroke is one of the devastating complications following coronary artery bypass graft (CABG). Underlying carotid artery atherosclerotic disease is reported to be an independent risk factor. The optimal treatment strategy for these patients remains under debate.
Source: Journal of Vascular Surgery - May 28, 2023 Category: Surgery Authors: Junji Tsukagoshi, Yujiro Yokoyama, Tomohiro Fujisaki, Hisato Takagi, Takuro Shirasu, Toshiki Kuno Source Type: research

Paradoxical Emboli as a Cause of Stroke
We present two cases of PDE resulting in acute ischemic events. A 63-year-old female presented for evaluation of left upper extremity numbness. Imaging was significant for an acute right middle cerebral artery infarct and evidence of a large saddle pulmonary embolism. The patient's stroke was postulated to have been secondary to a patent foramen ovale (PFO). An 87-year-old male presented for evaluation of chest pain. The patient underwent three-vessel CABG and experienced an acute left hemispheric stroke post-operatively. Transthoracic echocardiogram demonstrated a biatrial thrombus transversing a PFO and was postulated to...
Source: The American Surgeon - February 28, 2023 Category: Surgery Authors: Ilya Sakharuk Peter Drevets Philip Coffey Wasef Nijim Vijay Patel Source Type: research

Evaluating the Safety of Transcarotid Artery Revascularization under Local Anesthesia Prior to Coronary Artery Bypass Grafting Surgery
Controversy exists regarding the timing of intervention for patients with critical coronary artery disease (CAD) awaiting coronary artery bypass and severe carotid artery stenosis (CAS). Transcarotid artery revascularization (TCAR) is a minimally invasive revascularization alternative through direct transcervical carotid access that minimizes the chance of arch manipulation and consequent antegrade embolic stroke rate. While the TCAR procedure can be performed under local anesthesia (monitored anesthesia care [MAC]) versus general anesthesia, the hemodynamic benefits of local anesthesia in patients with severe CAD are significant.
Source: Annals of Vascular Surgery - December 5, 2022 Category: Surgery Authors: Yamini Vyas, Eyerusalem Workneh, Joshua L. Leibowitz, Rajabrata Sarkar, Mehrdad Ghoreishi, Shahab Toursavadkohi Tags: Clinical Research Source Type: research

Evaluating The Safety of Transcarotid Artery Revascularization (TCAR) under Local Anesthesia prior to Coronary Artery Bypass Grafting (CABG) Surgery
Controversy exists regarding the timing of intervention for patients with critical coronary artery disease awaiting coronary artery bypass and severe carotid artery stenosis. Transcarotid artery revascularization (TCAR) is a minimally invasive revascularization alternative through direct transcervical carotid access that minimizes the chance of arch manipulation and consequent antegrade embolic stroke rate. While the TCAR procedure can be performed under local anesthesia (monitored anesthesia care, MAC) vs general anesthesia, the hemodynamic benefits of local anesthesia in patients with severe CAD are significant.
Source: Annals of Vascular Surgery - December 5, 2022 Category: Surgery Authors: Yamini Vyas, Eyerusalem Workneh, Joshua L. Leibowitz, Rajabrata Sarkar, Mehrdad Ghoreishi, Shahab Toursavadkohi Tags: Clinical Research Source Type: research

CALA: Cumulative Volume of Calcified Lesions of the Aorta in Cardiac Surgery
Thorac Cardiovasc Surg. 2022 Jul 11. doi: 10.1055/s-0042-1748194. Online ahead of print.ABSTRACTOne of the major key questions raised in this retrospective study was to identify any correlation of atherosclerotic plaque volume of the ascending aorta and aortic arch with adverse events such as postoperative stroke, critical illness polyneuropathy and myopathy, as well as delirium and all-cause in-hospital mortality. In a second phase of this study, we investigated the relationship between atherosclerotic plaque volume and adverse events regarding the construction of proximal anastomosis on coronary artery bypass grafting pr...
Source: Hand Surgery - July 11, 2022 Category: Surgery Authors: Stelios Ioannou Christian Braun Martin Hartrumpf Ralf-Uwe K ühnel Ali Vafa Filip Schr öter Johannes Albes Source Type: research

Coronary Revascularization for Patients with Diabetes Mellitus: A Contemporary Systematic Review and Meta-Analysis
Conclusions: Previous literature regarding coronary revascularization in diabetic patients has consistently demonstrated superior outcomes for patients undergoing CABG over PCI. The development of 1st and 2nd generation DES have narrowed the gap between CABG and PCI, but CABG continues to be superior. Continued investigation with large randomized trials and retrospective studies including long term follow-up comparing CABG and 2nd generation DES is necessary to confirm the optimal intervention for diabetic patients.
Source: Annals of Surgery - June 1, 2022 Category: Surgery Tags: META-ANALYSES Source Type: research

Outcomes of simultaneous carotid endarterectomy and coronary artery bypass grafting: A single centre experience
CONCLUSIONS: Synchronous CEA/CABG procedure can be performed with acceptable results in patients having a high risk of stroke, septuagenarians and older.PMID:35491987 | DOI:10.1177/17085381221098281
Source: Vascular - May 2, 2022 Category: Surgery Authors: Aleksandras Antu ševas Adomas Aladaitis Linas Veli čka Raminta Černevičiūtė Agn ė Gimžauskaitė Emilija Bernotait ė Donatas In čiūra Source Type: research

Single Versus Multiple Arterial Revascularization in Patients With Reduced Renal Function: Long-term Outcome Comparisons in 23,406 CABG Patients From Ontario, Canada
Objective: To compare the long-term outcomes of MAR versus SAR in patients with renal insufficiency. Summary of Background Data: Previous studies have been insufficiently powered to address whether MAR confers long-term benefit over SAR in patients with renal dysfunction who require CABG. Methods: We conducted retrospective cohort study in Ontario, Canada of patients who underwent isolated CABG (n = 23,406). The primary outcome was MACE, defined as the composite of stroke, myocardial infarction, and repeat revascularization. We compared patients by matching them on the propensity to have received SAR vers...
Source: Annals of Surgery - February 5, 2022 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Carotid Duplex Poorly Predicts Stroke Risk During Transcatheter Aortic Valve Replacement
Patients undergoing surgical aortic valve replacement, in isolation or with concomitant coronary artery bypass grafting, have historically been screened for carotid artery disease prior to surgery. Over the past decade, transcatheter aortic valve replacement (TAVR) has incrementally become the predominant technique for the treatment of severe aortic stenosis. The relationship between internal carotid artery stenosis (ICAS) and risk of periprocedural stroke in the TAVR population is uncertain. We sought to evaluate our institution's outcomes with the TAVR procedure and the association with preoperative carotid duplex scan (CDS) results.
Source: Annals of Vascular Surgery - January 4, 2022 Category: Surgery Authors: Cameron St. Hilaire, Jaclyn DeRieux, Michael Shenoda, Kevin Casey Tags: Clinical Research Source Type: research

Carotid Subclavian Bypass for the Treatment of Coronary Subclavian Steal Syndrome
Braz J Cardiovasc Surg. 2021 Oct 21. doi: 10.21470/1678-9741-2020-0609. Online ahead of print.ABSTRACTCoronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.P...
Source: Hand Surgery - October 21, 2021 Category: Surgery Authors: Lucas Yuji Sonoda Maria da Gra ça Lepre Hawerroth T úlio Torres Vargas Luciano Batista Silveira Santos Thomas Rezende Diniz Walter Alvarenga de Oliveira Maria Ambrosina Cardoso Maia Source Type: research

Predictors of change in cardiovascular disease risk and events following gastric bypass: a 7-year prospective multicenter study
CONCLUSION: This study identified multiple presurgery factors that characterize patients who may have more cardiovascular benefit from RYGB, and patients who might require additional support to improve their cardiovascular health.PMID:33582036 | DOI:10.1016/j.soard.2020.12.013
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - February 14, 2021 Category: Surgery Authors: Amanda S Hinerman Samar R El Khoudary Abdus S Wahed Anita P Courcoulas Emma J M Barinas-Mitchell Wendy C King Source Type: research

Carotid endarterectomy should be performed first rather than combined with coronary bypass
I read with interest the article addressing timing of carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG)1 since I had just been referred a patient from a cardiac surgeon with the need for both CEA and CABG. I was gratified to learn that in patients with stable angina, performing CEA first compared equally to combined CEA and CABG (CCAB) with regard to both stroke rate and myocardial infarction (MI). From a strictly scheduling standpoint, performing a staged procedure is easier on surgeons and staff.
Source: Journal of Vascular Surgery - November 19, 2020 Category: Surgery Authors: Joseph J. Piotrowski Tags: Letter to the Editor Source Type: research

Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies.
CONCLUSION: Although the findings from this review of comparative studies of RCAB appear promising and suggest that RCAB may offer some benefits to patients, in the absence of randomized controlled trials, these results should be interpreted cautiously. PMID: 33155975 [PubMed - in process]
Source: Canadian Journal of Surgery - November 1, 2020 Category: Surgery Authors: Hammal F, Nagase F, Menon D, Ali I, Nagendran J, Stafinski T Tags: Can J Surg Source Type: research

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