Patients who undergo combined heart bypass and carotid endarterectomy procedures have a significantly increased risk of death or stroke, according to an article in the January 16 issue of Neurology.

The US study involved review of hospital discharge data from 657,877 patients who had been admitted to hospitals for carotid endarterectomy or coronary bypass surgery from 1993 to 2002.

The study found a 38 percent greater chance of death or postoperative stroke among patients with combined procedures compared to the risk of death or stroke from coronary artery bypass surgery alone.

The underlying rationales for combining both procedures are to protect the carotid artery from blockage during the heart bypass surgery and to lessen the risk of stroke by having just one procedure.

“The benefit of this combined procedure is controversial,” said author Richard M. Dubinsky, MD, MPH, with the University of Kansas Medical Center in Kansas City, Kansas, and a Fellow of the American Academy of Neurology. “Given this significant increase in postoperative stroke and death, a randomized clinical trial of the combined surgery is needed to determine the benefit, if any, compared to performing the operations in separate hospitalizations.”

Dubinsky says the increase in death or stroke could be due to the degree of narrowing of carotid arteries, the patient’s history of previous stroke, or other factors that could not be identified from the data. He says those two areas must be matched in any clinical trials.

In addition, Dubinsky noted the current study is the first to show that being female was slightly protective against postoperative death or stroke after combined procedures.