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Carotid artery stenting and cardiac surgery in symptomatic patients

Jan Van der Heyden1, Danihel Van Neerven, Uday Sonker

  • 1Department of Interventional Cardiology, St-Antonius Hospital, Nieuwegein, the Netherlands. janenvan@hotmail.com

JACC. Cardiovascular Interventions
|November 26, 2011
PubMed

Insights

Combining carotid artery stenting (CAS) and coronary artery bypass graft (CABG) surgery is feasible and safe for neurologically symptomatic patients. This approach offers a reliable alternative for high-risk individuals needing both procedures.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Interventional Cardiology

Background:

  • Patients undergoing coronary artery bypass graft (CABG) surgery with a history of stroke or transient ischemic attack face a significantly higher risk of perioperative stroke.
  • Prophylactic carotid endarterectomy is often considered for neurologically symptomatic patients with significant carotid artery disease scheduled for CABG.
  • Limited data exists on the combined outcomes of carotid artery stenting (CAS) and CABG in symptomatic patients.

Purpose of the Study:

  • To assess the feasibility and safety of performing carotid artery stenting (CAS) followed by coronary artery bypass graft (CABG) surgery.
  • To evaluate the combined outcomes in neurologically symptomatic patients requiring both procedures.

Main Methods:

  • A prospective, single-center study analyzed 57 consecutive patients.
  • Patients underwent CAS prior to undergoing cardiac surgery.
  • Periprocedural and long-term outcomes were meticulously recorded and analyzed.

Main Results:

  • Carotid artery stenting (CAS) achieved a high procedural success rate of 98%.
  • The combined rate of death, stroke, and myocardial infarction within the study period was 12.3%.
  • The combined rate of death and major stroke from CAS to 30 days post-cardiac surgery was 3.5%, with a 1.5% myocardial infarction rate.

Conclusions:

  • This study presents the first single-center findings on combined CAS-CABG outcomes in symptomatic patients.
  • The CAS-CABG strategy demonstrated reliable periprocedural and long-term results in this high-risk group.
  • This approach may serve as a valuable alternative to combined surgical procedures, though further randomized trials are necessary.
Abstract

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