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Different Strategies in Simultaneous Coronary and Carotid Artery Revascularization - A Single Center Experience
Jianbin Zhang1, Zhiqiang Dong2, Peng Liu1
1Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Insights
This study explored a hybrid approach for severe coronary artery disease (CAD) and carotid artery stenosis (CAS). Synchronous percutaneous coronary intervention (PCI), carotid endarterectomy (CEA), and coronary artery bypass grafting (CABG) showed comparable safety to CEA/CABG alone.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Optimal management for severe coronary artery disease (CAD) and carotid artery stenosis (CAS) is debated.
- A synchronous hybrid strategy involving PCI, CEA, and CABG was investigated.
Purpose of the Study:
- To evaluate the preliminary experience and safety of a synchronous hybrid strategy for patients with concomitant severe CAD and CAS.
- To compare the outcomes of synchronous PCI/CEA/CABG with synchronous CEA/CABG.
Main Methods:
- Retrospective analysis of 7 patients undergoing synchronous PCI/CEA/CABG and 36 patients undergoing synchronous CEA/CABG.
- Comparison of demographics, risk factors, operation time, blood loss, and 30-day outcomes.
Main Results:
- Demographics were comparable between the groups.
- Operation time and intraoperative blood loss showed no significant difference.
- The primary endpoint incidence (stroke, MI, death) was 14.29% for PCI/CEA/CABG vs. 5.56% for CEA/CABG, not statistically significant.
Conclusions:
- Synchronous PCI, CEA, and CABG may be safe and effective for managing complex CAD and CAS.
- Further randomized controlled trials are needed to confirm the suitability of this hybrid strategy.
Background:
The optimal management for patients with concomitant severe coronary artery disease (CAD) and carotid artery stenosis (CAS) remains controversial. We reported our preliminary experience on a synchronous hybrid strategy.
Methods:
Seven patients with synchronous percutaneous coronary intervention (PCI)/carotid endarterectomy (CEA)/coronary artery bypass grafting (CABG) and 36 patients with synchronous CEA/CABG were enrolled. Then we analyzed the demographics, risk factors and 30-day results of the 2 groups, retrospectively.
Results:
The 2 groups were comparable in demographics. The operation time was 312.14 ± 40.08 minutes for synchronous PCI/ CEA/CABG and 294.58 ± 47.62 minutes for synchronous CEA/CABG (P = 0.367). The intraoperative blood loss was 814.29±195.18 mL for synchronous PCI/CEA/CABG and 769.44 ± 330.21 mL for synchronous CEA/CABG (P = 0.731). There was no death in the 2 groups within 30 days. The incidence of primary endpoint [stroke, myocardial infarction (MI) and death] was 14.29% (1/7) in synchronous PCI/CEA/CABG group and 5.56% (2/36) in synchronous CEA/CABG group. The difference between the 2 groups was not statistically significant (P = 0.421).
Conclusion:
Synchronous PCI, CEA and CABG may be safe and effective in the management of patients with concomitant CAS and complicated multi-vessel CAD. The current data suggested that more studies and randomized controlled trials may be necessary to define whether this strategy is suitable for these patients.
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