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Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery
Oscar A Mendiz1, Carlos M Fava, Gustavo A Lev
1Department of Interventional Cardiology, University Hospital Favaloro Foundation, Buenos Aires, Argentina. omendiz@ffavaloro.org.
Insights
Synchronous carotid artery stenting and cardiac surgery offer a feasible hybrid approach for high-risk patients. This combined procedure demonstrated acceptable in-hospital and midterm outcomes, avoiding stroke or urgent re-intervention.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Concurrent severe carotid and cardiac disease presents a surgical challenge.
- Staged surgery is common, but optimal approach for unstable patients is debated.
- Hybrid procedures offer an alternative for high-risk individuals.
Purpose of the Study:
- To evaluate in-hospital and midterm outcomes of synchronous carotid artery stenting and cardiac surgery.
- To assess the feasibility and safety of this hybrid approach in a high-surgical-risk population.
Main Methods:
- A retrospective study included 54 consecutive patients from June 1998 to July 2012.
- Patients underwent carotid angioplasty with aspirin and heparin, followed immediately by cardiac surgery.
- Post-operative dual antiplatelet therapy (aspirin and clopidogrel) was administered after ruling out bleeding.
Main Results:
- Five in-hospital surgical-related deaths occurred.
- No strokes or urgent carotid re-interventions were reported.
- At a mean follow-up of 55 months, no new neurological deficits were observed, with one late death.
Conclusions:
- Synchronous carotid stenting and cardiac surgery are feasible in high-risk patients unsuitable for staged procedures.
- The hybrid approach demonstrated an acceptable complication rate.
- This strategy provides a viable option for complex cardiovascular and cerebrovascular disease management.
Background:
Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.
Methods:
From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.
Results:
There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1-144 months), there were no new neurological deficits, while one additional death occurred.
Conclusions:
In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.
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