Cardiac Surgery, with Synchronous Carotid Angioplasty, our Experience

The identification of carotid stenosis in patients proposed for coronary artery bypass grafting, proves that atherosclerosis is a systemic disease. In patients with carotid disease and in need of cardiac surgery, there are still questions about the best method of treatment - medical, surgical or percutaneous, the degree of stenosis considered for intervention and the best time for treatment (pre, peri or postoperative heart surgery). The surgical treatment of the carotid stenosis is currently the gold standard. However, percutaneous treatment has expanded its indications. It is our goal to present the initial results of our experience in the implementation of a synchronous strategy for the treatment of percutaneous carotid disease treatment, followed by cardiac surgery.

Between July/2013 and August/2017, 37 patients were eligible for this procedure. Demographic, perioperative and postoperative data were collected to evaluate the incidence of cerebrovascular complications (severe stroke, death due to stroke, transient ischemic stroke), cardiac complications (acute myocardial infarction (AMI)), or renal impairment.

The majority of patients (83.7%) were male, with a mean age of 74 years (51-90). Coronary artery disease was the most prevalent surgical indication (59%). Hypertension, dyslipidemia, and smoking, in this order of magnitude, were the most prevalent risk factors. One patient had documented previous stroke. The efficacy of carotid angioplasty was 97.3%, as in one patient it was impossible due to technical reasons. In six patients, the carotid procedure was associated with percutaneous treatment of coronary disease. The interval between both procedures was 1 hour, in average. In- hospital mortality was 5,4% (2 patients) and 1 AMI was documented. Renal injury and atrial fibrillation were the most common complications, found in 27% and 19%, respectively. The mean follow-up time was 523 days (50-1525 days). Two deaths were documented during follow-up. No re-stenosis was found.

The approach presented here (percutaneous treatment of carotid stenosis, concomitant treatment of coronary disease and proximity between procedures) is feasible and effective in reducing the risk of cerebrovascular complications in patients in need of cardiac surgery. Long-term follow-up results, associated with permeability studies, may boost this technique for clinical acceptance, with changes in guidelines, in this set of patients.