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Sequential hybrid carotid and coronary artery revascularization: immediate and mid-term results
Francesco Versaci1, Costantino Del Giudice, Antonio Scafuri
1Department of Cardiology, University of Tor Vergata, Rome, Italy.
Insights
Hybrid revascularization combining carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) is a feasible strategy for high-risk patients. This approach shows promise in minimizing adverse events in patients with severe carotid and coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Patients with elevated cardiovascular surgical risk often have concurrent carotid and coronary artery disease.
- Minimizing adverse events in this high-risk population is a critical clinical challenge.
- Traditional treatment strategies may not be optimal for patients requiring both carotid and coronary revascularization.
Purpose of the Study:
- To investigate the safety and efficacy of a novel hybrid revascularization strategy.
- To evaluate the combined approach of simultaneous carotid artery stenting (CAS) followed immediately by coronary artery bypass grafting (CABG).
- To assess event rates in patients with severe carotid stenosis and coronary artery disease and high surgical risk.
Main Methods:
- A study involving 37 high-risk patients (EuroSCORE ≥5) with severe carotid and coronary artery disease.
- Patients underwent CAS immediately followed by CABG.
- Primary endpoint: 30-day incidence of stroke, myocardial infarction, or death. Secondary endpoints included transient ischemic attack, local/systemic complications, and longer-term outcomes.
Main Results:
- Procedural success rate was high at 97.3%.
- The 30-day cumulative incidence of disabling stroke, myocardial infarction, or death was 8.1%.
- Two patients (5.4%) died within 30 days, one due to stroke post-CAS; another death occurred between 31 days and 6 months.
Conclusions:
- Hybrid revascularization using CAS followed by CABG is a feasible and promising strategy for elevated-surgical-risk patients.
- This combined approach offers a potential solution for patients with complex carotid and coronary artery disease.
- Further research may support this hybrid strategy as a valuable therapeutic option.
Background:
To minimize event rates in patients with elevated cardiovascular surgical risk, we investigated a new therapeutic strategy consisting of simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG).
Methods:
The study included 37 patients with severe carotid and coronary artery disease and a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5 or higher. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, myocardial infarction, or death at 30 days. Secondary end points were a combination of transient ischemic attack, major local complications, bleeding, and systemic complications within the 30 days after treatment, and any stroke, acute myocardial infarction, or death from day 31 through to the end of the follow-up. All clinical outcomes were assessed by an independent monitoring board.
Results:
The rate of procedural success was 97.3%. The 30-day cumulative incidence of disabling stroke, myocardial infarction, or death was 8.1%: 2 patients (5.4%) died, and 1 patient had a stroke immediately after carotid stenting. Another patient died between day 31 and 6 months after the intervention.
Conclusions:
Our findings indicate that in elevated-surgical-risk patients with carotid stenosis and coronary artery disease suitable for CABG, hybrid revascularization by CAS, immediately followed by CABG, is a feasible and promising therapeutic strategy.
