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Combo Artery Surgery Needs More Study

Researchers suggest more trials to determine safety of combined surgeries

TUESDAY, April 26, 2005 (HealthDay News) -- Combining carotid artery and coronary artery surgeries may increase the risk of stroke, according to new Canadian research.

In a study published in the April 26 issue of the journal Neurology, the researchers explained that some patients having coronary artery bypass graft (CABG) surgery also undergo carotid endarterectomy (CEA) at the same time -- the assumption being that combining the two surgeries may reduce the risk of subsequent stroke or death.

The study concluded that there is little evidence to support that theory.

Both surgeries have become relatively common. While CABG creates a detour around a blocked coronary artery, CEA removes plaque from the walls of one artery or both arteries in the neck that supply blood to the brain.

Even though the use of the combined CEA-CABG procedure has increased, the actual benefits to patients aren't clear.

"We sought to explore the use of these combined procedures in Canada, to evaluate its utilization over time, and to assess outcomes," study author Dr. Michael D. Hill, University of Calgary, said in a prepared statement.

He and his colleagues examined data from 131,762 patients who underwent CABG at Canadian hospitals between 1992 and 2001. Of those, 669 (0.51 percent) had combined CEA-CABG. Patients who had the combined procedure had an in-hospital death rate of 4.9 percent and a postoperative stroke rate of 8.5 percent, versus 3.3 percent and 1.8 percent, respectively, of patients who had CABG alone.

After making adjustments, the researchers concluded that there was no statistically significant difference in the risk of death between the two groups. However, those in the CEA-CABG group had a higher stroke risk (6.8 percent), than patients who had CABG alone (1.8 percent).

"Because the stroke risk of the combined surgical procedures remained significantly higher than in the CABG procedure alone, we believe further, randomized trials are necessary to demonstrate the appropriateness of combining these procedures," Hill concluded.

More information

The Cleveland Clinic Foundation has more about carotid artery disease.

SOURCE: American Academy of Neurology, news release, April 25, 2005
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