Left carotid endarterectomy with coronary artery bypass grafting (CABG)

Bhuvaneshwari1*, Sripreethi2, Jayamenon3

1Criticalcare Nurse, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital , Heart city, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital , Heartcity, Trichy, Tamil Nadu

*Correspondence

Abstract

Coronary artery disease (CAD) and carotid artery stenosis frequently coexist and increase the risk of myocardial infarction and stroke. This case study presents a patient who underwent Left Carotid Endarterectomy (CEA) combined with Coronary Artery Bypass Grafting, (CABG). Comprehensive medical, surgical, and nursing management contributed to a favorable postoperative outcome. Early diagnosis, timely intervention, and multidisciplinary care played a significant role in reducing complications and promoting recovery.

Keywords: Carotid artery stenosis; Coronary artery disease; Carotid Endarterectomy; Coronary Artery Bypass Grafting, (CABG), Myocardial ischemia

Introduction

Carotid artery stenosis is a narrowing of the carotid arteries caused by atherosclerotic plaque formation, increasing the risk of cerebrovascular accidents. Coronary artery disease results from atherosclerotic obstruction of coronary vessels, leading to myocardial ischemia. Patients with significant carotid stenosis and multivessel coronary artery disease may require simultaneous CEA and CABG to reduce the risk of stroke and cardiac events. This case study discusses the management and outcome of such a patient.

Case Presentation

A 63 year-old male presented   with a history of hypertension, type 2 diabetes mellitus for more than 20 years. He reported episodes of chest pain on exertion and transient dizziness over the previous three months. There was no previous history of stroke.

Present Complaints

  • Chest pain on exertion
  • Shortness of breath
  • Dizziness
  • Easy fatigability
  • Occasional transient weakness of the right upper limb

Diagnosis

Clinical Diagnosis

  • Severe Left Carotid Artery Stenosis
  • Triple Vessel Coronary Artery Disease

Investigations

ECG: Ischemic changes

Echocardiography: Mild left ventricular dysfunction

Carotid Doppler : >70% stenosis of left carotid artery

Coronary Angiography: Triple vessel disease

CT Imaging

Management

  • Medical Management
  • Antiplatelet therapy (Aspirin)
  • Statins (Atorvastatin)
  • Antihypertensive medications
  • Antidiabetic medications
  • Pain management
  • Antibiotic prophylaxis

Surgical Management

  • Left Carotid Endarterectomy performed to remove atherosclerotic plaque from the left carotid artery.
  • Coronary Artery Bypass Grafting (CABG) performed using graft vessels to bypass blocked coronary arteries.
  • Intraoperative monitoring and cardiopulmonary bypass support utilized as indicated.

Nursing Management

Preoperative Care

  • Baseline neurological assessment
  • Cardiac monitoring
  • Patient and family education
  • Medication administration as prescribed

Postoperative Care

  • Continuous ECG monitoring
  • Hemodynamic monitoring
  • Neurological assessment (GCS, pupil reaction, limb movement)
  • Monitoring chest tube drainage
  • Pain assessment and management
  • Respiratory care and chest physiotherapy
  • Wound care and infection prevention
  • Early mobilization
  • Monitoring intake and output

Discussion

Patients with concomitant carotid artery stenosis and coronary artery disease are at increased risk of perioperative stroke and myocardial infarction. Simultaneous CEA and CABG offer the advantage of treating both conditions during a single operative session, reducing overall morbidity. Careful perioperative monitoring is essential to identify neurological deficits, bleeding, arrhythmia, and hemodynamic instability. Nursing care plays a critical role in early detection of complications and enhancing postoperative recovery.

Outcome

The patient remained hemodynamically stable postoperatively. Neurological examination revealed no deficits. Chest tube drainage remained within acceptable limits, and wound healing was satisfactory. The patient was successfully extubated, mobilized early, and discharged with appropriate medications and follow-up instructions.

Conclusion

Combined Left Carotid Endarterectomy and CABG is an effective treatment option for patients with significant carotid stenosis and coronary artery disease. Successful outcomes depend on timely diagnosis, appropriate surgical intervention, and comprehensive multidisciplinary management, including specialized nursing care.

References

  • American Heart Association. (2021). Guideline for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 52(7), e364–e467.
  • Braunwald, E. (2022). Braunwald’s heart disease: A textbook of cardiovascular medicine (12th ed.). Elsevier.
  • Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.

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