Long-term results after simultaneous carotid and coronary revascularisation
Igor Zivkovic1, Stasa Krasic2, Petar Milačić1
1Department of Cardiac Surgery, 606093Dedinje Cardiovascular Institute, Belgrade, Serbia.
Insights
This study compared carotid artery stenting versus endarterectomy during coronary artery bypass surgery. Both revascularization strategies showed similar long-term adverse outcomes, emphasizing patient selection for optimal results.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Optimal revascularization strategy for patients with concomitant carotid and coronary artery disease remains unclear.
- Simultaneous coronary artery bypass surgery (CABG) with carotid endarterectomy or carotid artery stenting are common approaches.
- Long-term outcomes of these simultaneous revascularization strategies require further evaluation.
Purpose of the Study:
- To evaluate and compare the long-term results of simultaneous carotid artery stenting (CAS) or carotid endarterectomy (CE) in patients undergoing coronary artery bypass surgery (CABG).
Main Methods:
- Prospective, non-randomized, single-institution cohort study.
- Sixty patients undergoing simultaneous CAS and CABG (n=30) or CE and CABG (n=30) between 2012 and 2015.
- Primary endpoints included short- and long-term adverse events (transient ischemic attack, stroke, myocardial infarction, death) with a mean follow-up of 62 months.
Main Results:
- In-hospital mortality was higher in the CE group (6.6% vs. 0%), though not statistically significant.
- Rates of stroke and myocardial infarction were similar between the CAS and CE groups (6.6% and 3.3% vs. 13.3% and 0%, respectively).
- Intensive care unit readmission was higher in the surgical revascularization approach and predicted hospital mortality. Overall mortality was 14.28% in both groups during follow-up.
Conclusions:
- Direct comparison of CAS and CE is complex due to differing anatomical indications.
- Both carotid revascularization techniques play a crucial role in managing combined carotid and coronary disease.
- Careful patient selection based on specific indications is vital for achieving favorable short- and long-term outcomes.
Background:
The revascularisation strategy for concomitant carotid and coronary disease is unknown. Simultaneous or stage coronary artery stenting and carotid endarterectomy are the most common revascularisation approach in the CABG population. This study aimed to evaluate long-term results after simultaneous carotid artery stenting or carotid endarterectomy in patients who underwent coronary artery bypass surgery.
Methods:
This is a prospective cohort non-randomised single-institution study. During the period from 2012 to 2015, sixty consecutive patients (65.9 ± 7.41 mean) underwent simultaneous carotid artery stenting and coronary artery bypass surgery (n = 30) or simultaneous carotid endarterectomy and coronary artery bypass surgery (n = 30). The primary endpoints were short- and long-term rates of adverse events (transient ischemic attack, stroke, myocardial infarction, and death). The mean follow-up was 62.05 ± 11.12 months.
Results:
In-hospital mortality was insignificantly higher in the carotid endarterectomy, and coronary artery bypass surgery group (6.6% vs. 0%), the rate of stroke and myocardial infarction was similar (13.3% and 0% in the carotid endarterectomy and coronary artery bypass surgery group vs. 6.6% and 3.3% in the carotid artery stenting and coronary artery bypass surgery group, respectively). The intensive care unit readmission was significantly higher in the surgical revascularisation approach; it was an independent predictor of hospital mortality. The overall mortality during the follow-up period was 14.28% in both groups. Freedom of the composite adverse outcomes (stroke, myocardial infarction, and death) was 78.55%.
Conclusion:
Comparing two revascularisation strategies is not straightforward due to different anatomical indications for carotid artery stenting and endarterectomy. We consider that each technique has an essential role in carotid revascularisation. Good selection of patients, according to indications, contributes to satisfactory short- and long-term results.
