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Title: Simultaneous or staged carotid artery stenting and coronary artery bypass grafting as novel revascularization strategy for patients with severe, concomitant carotid and coronary disease
Abstract:
Carotid endarterectomy combined with coronary artery bypass grafting (CABG) performed in patients with mulivessel coronary artery disease (CAD) concomitant with internal carotid artery stenosis is a high risk procedure. The aim of this study is to assess safety of novel revascularization strategies: simultaneous or staged carotid artery stenting (CAS) combined with CABG and their major adverse events (myocardial infarction, stroke, death) periprocedural and on long term observation. Between 2009 and 2014 67 patients (age 69,2±6,6; 53 – 83years; 76% male) with multivessel CAD coexisting with symptomatic ICA stenosis > 50% or asymptomatic stenosis ≥80% had CAS combined with CABG. Patients with CCS III, IV/unstable angina or NSTEMI had hybrid procedure: CAS immediately followed by CABG (hCAS+CABG group, n=37). Those with stable CCS II-III angina had staged CAS-CABG: CABG was performed 4-5 weeks after CAS (dCAS-CABG group, n=30). All CAS procedures were done according to ‘tailored-CAS’ algorithm with proper selection of neuroprotection device (proximal in 19 (51%) vs. 14 (46%) patients from hCAS+CABG vs. dCAS-CABG group respectively; p= 0,703 or distal in other cases) and stent type (open or closed cell). Most CABG procedures were normothermic cardiopulmonary bypass. Each patient from hCAS+CABG vs. dCAS-CABG group received 2,2±0,7 (1-4) vs. 2,3 ±0,5 (1-3) grafts, respectively; p=0, ; 581. CAS procedure was free from any major complication. In hCAS+CABG group one periprocedural myocardial infarction and one death (5,4%) after CABG were noted; another two deaths were noted on long term observation. In dCAS-CABG group there was no major periprocedural (p=0,294) or long-term complications. CAS simultaneous, hybrid or staged with CABG is a safe revascularization strategy with low complication rate for patients with severe carotid and coronary disease.
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Last modified:
Mar 14, 2023
In our library since:
Apr 14, 2016
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51
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http://dl.cm-uj.krakow.pl:8080/publication/4069
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| Edition name | Date |
|---|---|
| ZB-124217 | Mar 14, 2023 |
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