Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2023; 11(36): 8581-8588
Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8581
Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports
Faisal Khader AlGhamdi, Abdulmajeed Altoijry, Abdulrahman AlQahtani, Mohammed Yousef Aldossary, Sultan Omar AlSheikh, Kaisor Iqbal, Walid Abdulaziz Alayadhi
Faisal Khader AlGhamdi, Walid Abdulaziz Alayadhi, Department of Cardiac Surgery, King Saud University, Riyadh 11322, Saudi Arabia
Abdulmajeed Altoijry, Sultan Omar AlSheikh, Kaisor Iqbal, Department of Surgery, King Saud University, Riyadh 11322, Saudi Arabia
Abdulrahman AlQahtani, King Fahad Cardiac Center, King Saud University Medical City, Riyadh 11322, Saudi Arabia
Mohammed Yousef Aldossary, Department of General Surgery, King Saud University, Riyadh 11322, Saudi Arabia
Mohammed Yousef Aldossary, Department of Surgery, Dammam Medical Complex, Dammam 32245, Saudi Arabia
Author contributions: AlGhamdi FK, Altoijry A, AlQahtani A, Aldossary MY, AlSheikh SO, Iqbal K, and Alayadhi WA contributed to the study design, literature review, and manuscript writing; AlGhamdi FK, AlQahtani A, and Aldossary MY contributed to the data collection and analysis; and all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from all of the patients for publication of this case series and accompanying images. A copy of the written consent is available for review upon request.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Faisal Khader AlGhamdi, MBBS, Surgeon, Department of Cardiac Surgery, King Saud University, 7804 Street No. 18, Riyadh 11322, Saudi Arabia. falghamdi3@ksu.edu.sa
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: November 13, 2023
Revised: November 19, 2023
Accepted: December 13, 2023
Article in press: December 13, 2023
Published online: December 26, 2023
Processing time: 64 Days and 11.3 Hours
Abstract
BACKGROUND

One of the major perioperative complications for coronary artery bypass graft (CABG) is stroke. The risk of perioperative stroke after CABG is approximately 2%. Carotid stenosis (CS) is considered an independent predictor of perioperative stroke risk in CABG patients. The optimal management of such patients has been a source of controversy. One of the possible surgical options is synchronous carotid endarterectomy (CEA) and CABG. Here, we have presented 4 cases of successful synchronous CEA and CABG.

CASE SUMMARY

Our center’s experience with 4 cases of significant carotid artery stenosis, which were successfully managed with combined CEA and CABG, are detailed. The first case was a female who presented for CABG after a ST-elevation myocardial infarction. She had right internal carotid artery (ICA) occlusion and 90% left ICA stenosis. The second case was a male who was electively admitted for CABG. It was discovered that he had left ICA occlusion and 90% right ICA stenosis. The third case was a male with a history of stroke, two months prior to admission. He presented with non-ST-elevation myocardial infarction. Preoperatively, it was discovered that he had > 90% right ICA stenosis. The final case was a male who was electively admitted for CABG. It was discovered that he had bilateral > 90% ICA stenosis. We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.

CONCLUSION

Our case series demonstrated that synchronous CEA and CABG was safe. A multicenter study with additional patients is needed. It is necessary for clinicians to screen for CS in high-risk patients with features.

Keywords: Carotid artery stenosis; Carotid endarterectomy; Coronary artery bypass grafting; Coronary artery disease; Synchronous; Case report

Core Tip: The risk of perioperative stroke after coronary artery bypass graft (CABG) is 2%. A hemodynamically significant carotid artery stenosis is found in 7% of patients undergoing CABG. Carotid stenosis is considered an independent predictor for the risk of perioperative stroke in CABG patients. The optimal management of such patients has been a source of controversy, but one of the possible surgical options is combined carotid endarterectomy and CABG. Our case series suggested that this option is safe for the management of this population of patients.