Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (CABACS): a randomized controlled trial

• Applicant: Professor Dr. Christian Weimar
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology ; Cardiology, Angiology
• Term: from 2010 to 2015
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 128961729

• Final Report Year: 2017

Final Report Abstract

The optimal operative strategy in patients with asymptomatic severe carotid artery disease undergoing coronary artery bypass grafting (CABG) has been a matter of debate for decades. No benefit of combined carotid endarterectomy (CEA) for either perioperative risk nor long-term stroke risk has been shown so far. The multicenter CABACS trial randomized patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST ultrasound criteria to combined CEA and CABG versus isolated CABG. Enrolment into the study had to be stopped by the end of 2014 due to withdrawal of funding following insufficient recruitment. From 2010 to 2014, a total of 129 patients were enrolled at 16 centers in Germany and 1 center in the Czech Republic. At 30 days, the rate of any stroke or death in the intention-to-treat population was 12/65 (18.5%) in patients receiving synchronous CEA+CABG as compared with 6/62 (9.7%) in patients receiving isolated CABG (absolute risk reduction, 8.8%; pWALD=0.12). Also for all secondary endpoints at 30 days and 1 year, there was no evidence for a significant treatment group effect although patients undergoing isolated CABG tended to have better outcomes. Five-year follow-up of patients is still ongoing. Due to the insufficient sample size, no significant difference could be shown between both treatment groups. Unexpectedly, we observed a greater than 2-fold higher overall event rate compared to previously published data which may result from the relatively high age of our study population, treatment quality as well as a systematic follow-up by study neurologists. Although our results cannot rule out a treatment group effect, superiority of the combined CEA+CABG approach seems unlikely. These findings should also impact future treatment recommendations.

Publications

• Randomized comparison of synchronous CABG and carotid endarterectomy vs isolated CABG in patients with asymptomatic carotid stenosis: the CABACS trial. Int J Stroke 2012;7(4):354-60
  Knipp S, Scherag A, Beyersdorf F, Cremer J, Diener HC, Haverich JA, Jakob HG, Mohr W, Ose C , Walterbusch G, Welz A
  
• Die Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (CABACS) RCT Studie: Rationale, Stand und Perspektiven. Gefässchirurgie 2013;18:638-643
  Weimar C, Holst T, Scherag A, Diener HC, Jakob HG, Knipp S