Impact of Adding Carotid Endarterectomy to Supra-Aortic Trunk Surgical Reconstruction

Abstract Objectives Up to 20% of patients requiring open supra-aortic trunk reconstruction (SAT) have significant carotid artery stenosis. The addition of carotid endarterectomy (CEA) to SAT has been described. Yet, additive risks are not well defined and controversy remains as to whether concomitant CEA increases stroke risk. This study assessed the perioperative effects of adding CEA to SAT. Methods Using the National Surgical Quality Improvement Program (NSQIP), patients who underwent SAT from 2005-2015 were evaluated. SAT+CEA were identified. An isolated SAT cohort (ISAT) was created by removing patients who underwent concurrent secondary procedures. Non-occlusive indications were excluded. SAT+CEA were compared with ISAT as well as a propensity-matched ISAT cohort. Primary outcomes were 30-day stroke, death, and composite stroke/death/myocardial infarction (SDM). Univariate and logistic regression analyses were performed. Results After review, 1,515 patients were identified: 1,245 (82%) ISAT and 270 (18%) SAT+CEA. Most were female (56%), 86% were Caucasian, and 24% were symptomatic. Average age was 65±12 years and SAT+CEA were older (69 vs 64 years, p Conclusions Addition of CEA does not confer increased perioperative stroke or SDM risk over isolated SAT. Perioperative outcomes appear to be more affected by disseminated disease risk factors than the addition of CEA. In patients undergoing SAT, it is reasonable to consider performing combined CEA in populations with tandem carotid bifurcation disease and appropriate operative risk profile.