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Risk of death increases with combined heart and stroke prevention surgery
January 16, 2007ST. PAUL, Minn — 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.
American Academy of Neurology
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.
American Academy of Neurology
Carotid Endarterectomy Current Events and Carotid Endarterectomy News RSSHigher carotid arterial stenting rates associated with poorer clinical outcomes
Among eligible Medicare beneficiaries, increased use of carotid arterial stenting (CAS) procedures to treat carotid stenosis-the narrowing of the carotid artery-is associated with higher rates of mortality and adverse clinical outcomes, including heart attack and stroke, according to researchers from the University of Pennsylvania School of Medicine.
Study examines impact of managed care on stroke prevention surgery
Policymakers and economists often promote managed-care plans based on the assumption that they prevent the overuse of unnecessary surgical procedures or help steer patients to high-quality providers, compared to traditional fee-for-service insurance plans.
Study finds stroke-prevention surgery safe in growing 80-plus population
New research published in the October issue of Journal of the American College of Surgeons challenges the current opinion that patients in their eighties, who are often deemed "high-risk" due to their advanced age, should not undergo carotid endarterectomy - a stroke-preventing surgical procedure that clears blockages from the neck's carotid arteries.
Surgery unnecessary for 95 percent of those with asymptomatic carotid stenosis
Research led by Dr. David Spence of Robarts Research Institute at The University of Western Ontario shows that with more intensive medical therapy, the risk of stroke has become so low that at least 95 per cent of patients with asymptomatic carotid stenosis (ACS) would be better off with medical therapy than with surgery or stenting.
For high-risk patients, stroke-prevention surgical procedure does not equate with high surgical risk
New research published in the August issue of the Journal of the American College of Surgeons shows that "high-risk" patients with multiple medical conditions, including high blood pressure and coronary artery disease, can safely undergo carotid endarterectomy - a stroke-preventing surgical procedure that clears blockages from the neck's carotid arteries.
Scientists develop new techniques for detecting harmful blood clots/air bubbles in arteries
New techniques for detecting emboli (harmful blood clots/air bubbles in arteries) developed at the University of Leicester have played a major role in dramatically reducing stroke rates after carotid endarterectomy. This is an operation designed to remove narrowings in the main arteries supplying the brain before they can cause a stroke.
Vascular surgeons ask, what's next for carotid artery stenting?
A procedure called carotid artery stenting (CAS) has emerged as a minimally invasive alternative to surgery, called carotid endarterectomy (CEA), for patients with dangerous narrowing of the arteries supplying blood to the brain.
Arterial vascular disease underdiagnosed, undertreated in older US women
Though arterial vascular disease is widespread and often deadly among older American women, doctors too often fail to spot and treat it, according to a new report by a team of vascular surgeons from the Columbia University Medical Center and Weill Cornell Medical College campuses of NewYork-Presbyterian Hospital.
2 carotid artery stenting studies show results comparable to AHA guidelines
Two carotid stenting trials examining patient outcomes demonstrated results that are comparable to guidelines established by the American Heart Association (AHA) for patients treated with carotid artery surgery.
Cerebral embolic protection and carotid stent systems
High-risk surgical patients in community hospital settings can safely benefit from the use of new embolus-removing and stent-inserting systems, according to a study presented today at the American College of Cardiology's Innovation in Intervention: i2 Summit in New Orleans, La.
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