[Staged carotid artery stent and cardiac surgery under cardiopulmonary bypass]

The presence of carotid disease in patients undergoing cardiac surgery has been known to increase the risk of peri-operative strokes. However, there are some controversies surrounding carotid artery stenting (CAS) in patients undergoing cardiac surgery with carotid disease. We experienced 5 cases of staged carotid artery stent and cardiac surgery under cardiopulmonary bypass. These cases represent 1.7% of the cardiac surgery between August 2006 and June 2009 at our hospital. There were 4 male and 1 female patient whose ages range from 58 to 81 years old (mean 73.0). Two cases were symptomatic and revealed carotid artery stenosis of 50% or more. The remaining 3 asymptomatic cases had 75% or more stenosis. Wallstent RP stents were used in 3 of the cases, and PRECISE stents in the remaining 2. The mean time of carotid angioplasty and stenting was 101 ± 22 minutes. Among the 5 cases, we experienced 2 periprocedural events. One developed bradycardia and cardiac arrest due to severe aortic valve stenosis, which was promptly improved by temporary cardiac pacing. The other experienced transient hemiparesis. The mean period of time between CAS and cardiac surgery was 53 days, with a range of 23 to 78 days. There were no post-operative deaths or strokes. All 5 cardiac operations were performed successfully. Further cooperation among cardiologists, cardiac surgeons and neurosurgeons is suggested for more careful circulatory assessment during CAS in patients with severe cardiac disease.