The interval between carotid artery stenting and open heart surgery is related to perioperative complications
Hui Dong1, Xiongjing Jiang1, Meng Peng1
1Department of Cardiology, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
For patients needing both carotid artery stenting (CAS) and open heart surgery (OHS), waiting more than 5 days between procedures may reduce complications. This interval appears safer for preventing major stroke and neurological death.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Patients undergoing open heart surgery (OHS) with significant carotid stenosis face elevated perioperative stroke risks.
- Optimal timing for carotid artery stenting (CAS) before OHS is a critical clinical consideration.
Purpose of the Study:
- To evaluate 30-day outcomes following carotid artery stenting (CAS) and open heart surgery (OHS).
- To determine the optimal time interval between CAS and OHS to minimize periprocedural complications.
Main Methods:
- A cohort of 154 inpatients undergoing both CAS and OHS between January 2005 and June 2010 were analyzed.
- Outcomes were assessed up to 30 days post-OHS, focusing on a composite of major stroke or neurological death as the primary endpoint.
Main Results:
- The incidence of major stroke or neurological death was 3.2%.
- An interval of ≤5 days between CAS and OHS independently predicted a higher incidence of the primary endpoint (OR, 14.06).
- Congestive heart failure and an interval of ≤5 days between procedures were independent risk factors for major adverse events (stroke, myocardial infarction, or death).
Conclusions:
- Carotid artery stenting (CAS) followed by open heart surgery (OHS) is a safe and feasible approach.
- A waiting period of >5 days between CAS and OHS may reduce the risk of periprocedural complications, particularly major stroke and neurological death.
Objectives:
To assess 30-day outcomes and the optimal interval between carotid artery stenting (CAS) and open heart surgery (OHS).
Background:
Whether or not they show symptoms of carotid atherosclerosis, patients with significant carotid stenosis who underwent OHS face a high risk of perioperative stroke. Planning appropriate treatment for carotid stenosis before OHS has become an important clinical issue.
Methods:
From January 2005 to June 2010, 154 inpatients scheduled for CAS and OHS were recruited and followed up for 30 days after OHS. The primary end point was a composite of major stroke or neurological death. The secondary end points included a composite of major stroke, myocardial infarction (MI) or any death, minor stroke, and acute kidney injury (AKI).
Results:
The incidence of the primary end point, the composite of major stroke, MI or any death, minor stroke and AKI was 3.2%, 5.8%, 2.6%, and 4.5%, respectively. Only an interval between CAS and OHS of ≤5 days could independently predict the incidence of the primary end point (OR, 14.06, 95% CI, 1.52-130.13; P=0.020). Moreover, congestive heart failure (OR, 7.07, 95% CI, 1.55-21.27; P=0.012) and an interval between CAS and OHS of ≤5 days (OR, 7.05, 95% CI, 1.58-31.40; P=0.010) were identified as independent risk factors for the composite of major stroke, MI, or any death.
Conclusions:
Our findings indicate that CAS followed by OHS is safe and feasible. More importantly, an interval between CAS and OHS of >5 days may decrease periprocedural complications, especially major stroke and neurological death.
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