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Background  Our retrospective single-center study aimed to evaluate the safety of the carotid endarterectomy (CEA) in comparison to patients with untreated asymptomatic carotid stenosis ≥60% before CABG.    Methods  This single-center retrospective study included 174 patients with asymptomatic unilateral carotid stenosis treated between 2004 and 2017 with CABG. Thereof 106 patients had CEA before cardiac surgery either by a simultaneous ( n  = 62) or staged ( n  = 44) approach. Patients with untreated carotid stenosis served as control (no-CEA group;  n  = 68).    Results  The mean stenosis grade was higher in the CEA group (CEA 83% (±1), no-CEA 71% (±1)  p  < 0.0001). The overall stroke rate was 5/174 (3%) and was due to a high incidence of stroke in the no-CEA group (CEA: 0/106 (0%); No-CEA 5/68 (7%)  p  = 0.0083). The overall mortality was 1% and comparable between the groups (CEA: 2/106 (2%); No-CEA 0/68 (0%)  p  = 0.5211). Stroke related mortality was not observed. The groups were similar regarding the incidence of myocardial infarction ( p  = 1.0), atrial fibrillation ( p  = 0.1931), delirium ( p  = 0.2106) and IMC/ICU stay ( p  = 0.1542). No significant difference in the subgroup analysis was found between the simultaneous and staged approach regarding the myocardial infarction ( simultaneous : 1/62 (1%);  staged:  1/44 (1%);  p  = 1.0).    Conclusions  CEA performed as a staged procedure in local anesthesia or a simultaneous procedure in general anesthesia, may reduce the stroke risk prior to CABG.

bmc cardiovascular disorders

Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: a retrospective study