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Coronary artery bypass grafting for left main disease and the risk of stroke: Incidence, aetiology and prevention
Publication date: Available online 3 October 2016 Source:The Surgeon Author(s): Ana-Catarina Pinho-Gomes, David P. Taggart This review explores the association between left main disease and the increased risk of perioperative stroke following coronary artery bypass grafting, specifically addressing the potential underlying mechanisms and its potential prevention. In particular, this correlation appears stronger for patients with left main disease when compared to patients with isolated triple vessel disease. Even though evidence on this topic is limited and of modest quality, there appears to be a significant association ...
Source: The Surgeon - October 3, 2016 Category: Surgery 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

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 Stenting Prior to Coronary Bypass Surgery: An Updated Systematic Review and Meta-Analysis.
CONCLUSIONS: In a cohort of predominantly asymptomatic patients with unilateral carotid stenoses, the 30-day rate of death/stroke was about 8%. Notwithstanding the effect of potential biases, this meta-analysis did not find evidence that outcomes after same-day CAS + CABG were higher than after staged interventions. However, outcomes were poorer in neurologically symptomatic patients. More data are required to establish the optimal antiplatelet strategy in patients undergoing same-day or staged CAS + CABG. PMID: 28094166 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - January 12, 2017 Category: Surgery Authors: Paraskevas KI, Nduwayo S, Saratzis AN, Naylor AR Tags: Eur J Vasc Endovasc Surg 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

Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.
CONCLUSIONS: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Unique identifier: NCT02319083. PMID: 30197287 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - September 6, 2018 Category: Surgery Authors: Santarpino G, Nicolini F, De Feo M, Dalén M, Fischlein T, Perrotti A, Reichart D, Gatti G, Onorati F, Franzese I, Faggian G, Bancone C, Chocron S, Khodabandeh S, Rubino AS, Maselli D, Nardella S, Gherli R, Salsano A, Zanobini M, Saccocci M, Bounader K, R Tags: Eur J Vasc Endovasc Surg Source Type: research

Revascularization by carotid artery stenting and off‐pump coronary artery bypass
ConclusionOur findings demonstrate that for patients with carotid and coronary artery disease, both hybrid and staged revascularization by CAS and OPCAB are feasible and safe therapeutic strategies with good early and long‐term outcomes. However, our results have to be substantiated by larger scale studies and randomized trials.
Source: ANZ Journal of Surgery - April 1, 2014 Category: Surgery Authors: Tao Yang, Lefeng Zhang, Xianqiang Wang, Hui Dong, Xiongjing Jiang, Hansong Sun Tags: Original Article Source Type: research

Revascularization by carotid artery stenting and off ‐pump coronary artery bypass
ConclusionOur findings demonstrate that for patients with carotid and coronary artery disease, both hybrid and staged revascularization by CAS and OPCAB are feasible and safe therapeutic strategies with good early and long‐term outcomes. However, our results have to be substantiated by larger scale studies and randomized trials.
Source: ANZ Journal of Surgery - April 2, 2014 Category: Surgery Authors: Tao Yang, Lefeng Zhang, Xianqiang Wang, Hui Dong, Xiongjing Jiang, Hansong Sun Tags: VASCULAR SURGERY Source Type: research

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

Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database.
Abstract Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of ...
Source: Vascular - May 29, 2014 Category: Surgery Authors: Kfoury E, Dort J, Trickey A, Crosby M, Donovan J, Hashemi H, Mukherjee D Tags: Vascular Source Type: research

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis.
CONCLUSION: The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results. PMID: 32493182 [PubMed - as supplied by publisher]
Source: Vascular - June 2, 2020 Category: Surgery Authors: Tzoumas A, Giannopoulos S, Charisis N, Texakalidis P, Kokkinidis DG, Zisis SN, Machinis T, Koullias GJ Tags: Vascular Source Type: research

Protamine sulfate use during tibial bypass does not appear to increase thrombotic events or affect short-term graft patency.
CONCLUSIONS: Heparin reversal with protamine sulfate after tibial or peroneal bypass grafting is not associated with higher cardiovascular morbidity, bypass thrombosis, amputation, or mortality. Additionally, there was no statistically significant difference in post-operative bleeding or thrombosis complications for patients who did not receive protamine, although the findings are suggestive of a potential difference in a more adequately powered study. Our results suggest that protamine sulfate is safe for intraoperative use without increased risk of thrombotic complications or early tibial bypass graft failure. PMID:...
Source: Vascular - May 10, 2020 Category: Surgery Authors: Phair J, Futchko J, Trestman EB, Carnevale M, Friedmann P, Shukla H, Garg K, Koleilat I Tags: Vascular Source Type: research

Carotid endarterectomy is not indicated for most patients scheduled for coronary artery bypass grafting
Klarin et  al1 evaluated whether performing concomitant carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in patients with concurrent carotid and coronary atherosclerotic disease is associated with reduced postoperative stroke rates compared with those undergoing CABG alone (ie, without CEA).1 They included 994 off-pump CABG patients (497 CABG only and 497 CABG-CEA) and 5952 on-pump CABG patients (2976 CABG only and 2976 CABG-CEA). For on-pump operations, patients undergoing concomitant CEA and CABG had no difference in rates of in-hospital stroke (odds ratio [OR], 0.93; 95% confi dence interval [CI]...
Source: Journal of Vascular Surgery - July 22, 2020 Category: Surgery Authors: Kosmas I. Paraskevas Tags: Letter to the Editor 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

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