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Simultaneous carotid artery stenting and heart surgery: expanded experience of hybrid surgical procedures
Luigi Chiariello1, Paolo Nardi1, Antonio Pellegrino1
1Cardiac Surgery Unit, Tor Vergata University Policlinic of Rome, Italy.
Insights
This study shows that same-day hybrid revascularization for carotid artery stenting and coronary artery bypass grafting is safe and effective. The hybrid approach offers a valid therapeutic option for patients with combined carotid and cardiac conditions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Simultaneous treatment of carotid artery stenosis (CAS) and coronary artery disease (CAD) or other cardiac conditions presents a clinical challenge.
- Hybrid revascularization combines minimally invasive stenting with open-heart surgery for comprehensive patient care.
Purpose of the Study:
- To evaluate the 10-year outcomes of same-day hybrid revascularization.
- Assess the safety and efficacy of combining carotid artery stenting (CAS) with coronary artery bypass grafting (CABG).
- Extend the evaluation to patients undergoing CAS alongside non-coronary cardiac surgeries.
Main Methods:
- A cohort of 132 patients underwent same-day CAS and CABG (n=97) or CAS with other cardiac procedures (n=35).
- Standardized antiplatelet therapy (aspirin and clopidogrel) and anticoagulation (warfarin, when indicated) protocols were followed.
- Mean follow-up duration was 53 months.
Main Results:
- In-hospital mortality was 3.8% overall (2.1% in CABG group, 8.6% in other cardiac surgery group).
- No perioperative myocardial infarction or stroke occurred in the CABG group; stroke rate was 2.86% in the other cardiac surgery group.
- Late survival was 81% ± 10%, with 92% ± 3.2% in the CABG group and 80% ± 11% in the other cardiac surgery group.
Conclusions:
- Same-day hybrid revascularization is a safe and effective approach for patients with concomitant CAS and CAD or other cardiac lesions.
- The hybrid strategy demonstrates favorable early and long-term results, particularly for noncomplex cases.
- This approach is a viable therapeutic option for managing complex cardiovascular and cerebrovascular disease simultaneously.
Background:
The aim of this study was to evaluate 10-year results of same-day hybrid revascularization of concomitant carotid artery disease by stenting (CAS) and coronary artery disease by coronary artery bypass grafting (CABG), later also applied to patients requiring CAS and other than coronary open heart cardiac surgery.
Methods:
One hundred thirty-two consecutive patients (70 ± 8 years, 102 men) underwent same-day CAS and CABG (group 1, n = 97) or other cardiac surgical procedures (aortic ± mitral valve surgery ± ascending aorta replacement ± CABG; group 2, n = 35). In both groups aspirin (100 mg daily) was started 2 days before CAS and permanently continued; clopidogrel, 300 mg initially followed by 75 mg daily, was started 6 hours after surgery and discontinued 1 month later. In group 2, when required, warfarin was started and aspirin discontinued on the second postoperative day. Mean follow-up was 53 ± 24 months.
Results:
Overall in-hospital mortality was 3.8% (2.1% in group 1 versus 8.6% in group 2; p = 0.02; 0% for noncoronary isolated procedures, 20% for complex cases), perioperative myocardial infarction was 0%, and stroke was 0.75% (0% in group 1 versus 2.86% in group 2; p = 0.26). Late survival was 81% ± 10% (92% ± 3.2% in group 1 versus 80% ± 11% in group 2; p = 0.45), and overall freedom from neurologic events was 84% ± 6%.
Conclusions:
Same-day hybrid approach appeared safe in terms of early and long-term results not only for CAS and isolated CABG but also for CAS and noncoronary isolated procedures. In complex cases, the rate of stroke and myocardial infarction seemed low; in-hospital mortality, as expected, was higher. Long-term survival appeared similarly satisfactory, thus confirming the hybrid approach as a valid therapeutic option for all patients with significant internal carotid artery stenosis associated with coronary and other cardiac lesions, at least for noncomplex cases.
