Carotid artery stenting followed by open heart surgery in 323 patients: One-year results and influencing factors

Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility

BACKGROUND

Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a "bridging" protocol for staged CAS-CTS.

METHODS

A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint.

RESULTS

11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24-288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes.

CONCLUSIONS

For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.

Same-Day Carotid Artery Stenting and Coronary Artery Bypass Surgery

BACKGROUND

The optimal treatment strategy for patients with severe carotid artery disease undergoing coronary artery bypass grafting is still problematic. The important question is whether it is necessary to treat significant carotid disease in patients who have undergone coronary artery bypass grafting. This study analyzed short- and midterm results after same-day carotid artery stenting and coronary artery bypass grafting.

METHODS

From 2013 to 2020, a total of 69 patients were enrolled in the study. Same-day carotid artery stenting and coronary artery bypass grafting were performed in all patients. The study's primary end points were the evaluation rate of stroke, myocardial infarction, and death within short- and midterm periods after the procedures.

RESULTS

The 30-day mortality was 0%. The occurrences of perioperative adverse events, namely stroke, myocardial infarction, and transient ischemic attack, were 1 (1.4%), 1 (1.4%), and 4 (5.8%), respectively. Mean (IQR) follow-up time was 28 (IQR, 17-43) months. Six (8.8%) patients died during this period. Fatal stroke was registered in 2 cases, and 1 patient experienced a disabling stroke with a fatal outcome. The other 3 patients died because of chronic renal disease, a traffic accident, and for an unknown reason, respectively. Midterm survival in the group was 91.2%.

CONCLUSION

The study showed that same-day carotid artery stenting and coronary artery bypass grafting for concomitant carotid and coronary disease treatment could be a promising and feasible therapeutic strategy.

Long-term results after simultaneous carotid and coronary revascularisation

BACKGROUND

The revascularisation strategy for concomitant carotid and coronary disease is unknown. Simultaneous or stage coronary artery stenting and carotid endarterectomy are the most common revascularisation approach in the CABG population. This study aimed to evaluate long-term results after simultaneous carotid artery stenting or carotid endarterectomy in patients who underwent coronary artery bypass surgery.

METHODS

This is a prospective cohort non-randomised single-institution study. During the period from 2012 to 2015, sixty consecutive patients (65.9 ± 7.41 mean) underwent simultaneous carotid artery stenting and coronary artery bypass surgery (n = 30) or simultaneous carotid endarterectomy and coronary artery bypass surgery (n = 30). The primary endpoints were short- and long-term rates of adverse events (transient ischemic attack, stroke, myocardial infarction, and death). The mean follow-up was 62.05 ± 11.12 months.

RESULTS

In-hospital mortality was insignificantly higher in the carotid endarterectomy, and coronary artery bypass surgery group (6.6% vs. 0%), the rate of stroke and myocardial infarction was similar (13.3% and 0% in the carotid endarterectomy and coronary artery bypass surgery group vs. 6.6% and 3.3% in the carotid artery stenting and coronary artery bypass surgery group, respectively). The intensive care unit readmission was significantly higher in the surgical revascularisation approach; it was an independent predictor of hospital mortality. The overall mortality during the follow-up period was 14.28% in both groups. Freedom of the composite adverse outcomes (stroke, myocardial infarction, and death) was 78.55%.

CONCLUSION

Comparing two revascularisation strategies is not straightforward due to different anatomical indications for carotid artery stenting and endarterectomy. We consider that each technique has an essential role in carotid revascularisation. Good selection of patients, according to indications, contributes to satisfactory short- and long-term results.

Safety and feasibility of simultaneous endovascular therapy for supra-arch multivessel stenosis in 256 Chinese patients

OBJECTIVES

To evaluate the safety and feasibility of simultaneous endovascular therapy for supra-arch multivessel stenosis.

BACKGROUND

Limited data are currently available on simultaneous intervention for supra-arch multivessel stenosis because of concerns regarding the high incidence of procedure-related complications.

METHODS

From January 2005 to December 2012, the clinical data of 256 consecutive inpatients who underwent simultaneous intervention for supra-arch multivessel stenosis were retrospectively analyzed. The primary end point was a composite of any type of stroke or neurological death within 30 days.

RESULTS

In total, 535 supra-arch vessels underwent endovascular therapy. In total, 234, 21, and 1 patient underwent simultaneous intervention of 2, 3, and 4 supra-arch vessels, respectively. The lesions involved only the anterior circulation in 40.2% (103/256), only the posterior circulation in 10.5% (27/256), and the combined circulations in 49.2% (126/256) patients. The overall procedural success rate was 99.6% (533/535). The incidence of the primary end point was 3.5%. According to the lesion location, the incidence of the primary end point was 3.9% (4/103), 0% (0/27), and 4.0% (5/126) in the patients who underwent endovascular treatment for the anterior circulation alone, posterior circulation alone, and combined circulations, respectively. According to the number of supra-arch lesions, the incidence of the primary end point was 3.4% (8/234), 4.8% (1/21), and 0% (0/1) in the patients who underwent simultaneous intervention of 2, 3, and 4 vessels, respectively.

CONCLUSIONS

The study showed that simultaneous intervention for supra-arch multivessel stenosis was safe and technically feasible.