Heart bypass with carotid endarterectomy increases death and stroke risk

Combination heart bypass and carotid endarterectomy can be risky according to a new review.
Heart bypass is done to reduce the risk of heart attack by ‘bypassing’ a blocked artery serving the heart. Carotid endarterectomy is a stroke prevention procedure which clears plaque from a blocked artery serving the brain. Sometimes both procedures are done at the same time, because the endarterectomy can protect the carotid artery from blocking during the bypass and also because it means only one operation has to be done. These two factors ought to reduce the risk of stroke although, in fact, the combination procedure remains controversial.

Researchers at the University of Kansas have been looking at outcomes in 657,877 patients admitted for bypass surgery or carotid endarterectomy either alone or in combination. The risk of death or postoperative stroke was 38 per cent greater when the procedures were combined compared to when they were used alone. The increase in death rate may be because of the degree of narrowing in the carotid arteries or a history of stroke among patients who had combination therapy. Further trials are needed to establish the value to the patient, if any, of combination therapy over bypass surgery or carotid endarterectomy performed as separate procedures.