Research

NEW MULTI-CENTER STUDY OF CAROTID ENDARTERECTOMY IN CORONARY ARTERY BYPASS

In April 2000, John J. Ricotta, MD, professor and chairman of surgery, was awarded a substantial grant from the National Institutes of Health to conduct a multi-center pilot study to test his hypothesis that carotid endarterectomy (CEA) reduces the risk of perioperative stroke in at-risk patients undergoing heart surgery for coronary artery bypass grafting (CABG). Stroke is the most serious non-cardiac complication of CABG surgery.

Called the CABEST study (Coronary Artery Bypass and Endarterectomy Staging Trial), this clinical research will take three years to complete, during which time Dr. Ricotta intends to collect data on 300 patients.

Stony Brook University Hospital is the coordinating center in this study. The other participating centers are: Sentara Norfolk General Hospital in Norfolk, VA (affiliated with the University of Virginia); New England Heart Institute at the Catholic Medical Center in Manchester, NH; Indiana University Medical Center in Indianapolis, IN; and the University of Arkansas for Medical Sciences Medical Center in Little Rock, AR.


When is it best to perform carotid endarterectomy in order to reduce the risk of stroke during/after coronary bypass surgery?


Patients are being randomized into one of four assignments. If the patient is symptomatic, he/she will be randomized into either a staged procedure with CEA performed first, followed by CABG, or into a combined CEA/CABG procedure. Asymptomatic patients will be randomized into either a staged procedure with CABG first, followed by CEA, or into a combined CEA/CABG procedure.

At present, there is disagreement on the optimal way to treat patients who require both CABG and CEA. Some surgeons do both operations under the same anesthetic, while others do each operation separately. Published experience in the medical literature has not shown a clear benefit for any one method of treatment.

Dr. Ricotta hopes to show that one of the methods is safer than the others, resulting in fewer strokes, heart attacks and deaths. When this pilot study is completed, he plans to go on to do an even larger study, involving more than 20 different medical centers.

For more information, please call the CABEST coordinator at 631-444-2017.

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