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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.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia ; kardiochirurgia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Piotr Odrowąż-Pieniążek

Date issued:

2015

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:4069

Call number:

ZB-124217

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

May 24, 2021

In our library since:

Apr 14, 2016

Number of object content hits:

46

Number of object content views in PDF format

46

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/4069

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ZB-124217 May 24, 2021
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