Carotid angioplasty in asymptomatic patients undergoing CABG surgery

Although there are studies reporting that carotid endarterectomy (CEA) is recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with severe carotid stenosis, controversies still exist. Carotid artery stenting (CAS) has been recently introduced as an alternative revascularization therapy in high-risk patients. The aim of this study was to demonstrate, whether CAS is safe as an alternative treatment to carotid CEA, in asymptomatic candidates for CABG surgery.

Forty-one patients with severe carotid and coronary artery disease were studied. The mean age was 65 years; 91% were males. Within 1 week of the CAS intervention all patients underwent CABG surgery. A brain protection device was used in all CAS interventions. Balloon PTA and stenting was performed in all subjects. Adjunctive therapy with heparin was used during the procedure and clopidogrel was started immediately after cardiac surgery. Patients were assessed neurologically before and after the procedure (immediately after the CAS, at 24h, at 30 days, at 3, 6 and 12 months). The primary end point was the incidence of TIA, stroke, or death at 30 days.

Internal carotid artery lesions of > 80%, were reduced by CAS to < 20% in all cases, achieving a procedural success of 100%. There were no neurological complications, such as TIA and stroke, or death, up to 12 months follow up. One patient developed acute coronary syndrome the day after CAS and was treated accordingly.

Our results show that CAS, with brain protection in asymptomatic patients undergoing CABG surgery is feasible and safe and could be a good alternative to CEA.