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Published on: August 12, 2014
Preventive Strategies for Perioperative Ischemic Heart Disease during Carotid Artery Stenting
Shinya Fukuta1, Mitsuhiro Iwasaki1, Hidekazu Yamazaki2
1Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Kanagawa, Japan.
Insights
Preoperative coronary artery assessment and intervention before carotid artery stenting (CAS) significantly reduced ischemic heart disease complications. This strategy, including adjunctive therapies, ensured no perioperative coronary ischemic events occurred in 224 patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Carotid artery stenting (CAS) carries a risk of perioperative coronary ischemic complications.
- Preoperative assessment of coronary artery disease is crucial for patients undergoing CAS.
- Implementing timely interventions can mitigate cardiac risks.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive strategy to prevent perioperative coronary ischemic complications in patients undergoing CAS.
- To assess the impact of preoperative coronary artery assessment and intervention on cardiac outcomes.
- To analyze the role of intraoperative adjunctive therapies in managing cardiac risks during CAS.
Main Methods:
- Retrospective analysis of 224 patients undergoing CAS between January 2014 and December 2021.
- Preoperative coronary artery computed tomography angiography (CTA) for stenosis assessment.
- Coronary revascularization or intraoperative adjunctive therapies (temporary transcutaneous cardiac pacemaker [TTCP] or intra-aortic balloon pumping [IABP]) based on stenosis severity.
Main Results:
- Coronary artery disease detected in 64% of patients; 41% required coronary revascularization.
- Preoperative coronary artery treatment performed in 34% of cases.
- Intraoperative adjunctive therapy used in 13% of cases.
- Zero instances of perioperative coronary ischemic complications were reported.
Conclusions:
- A proactive strategy involving preoperative coronary artery evaluation and intervention effectively prevents perioperative cardiac ischemic events in CAS patients.
- Tailored coronary artery treatment based on stenosis severity is key to reducing complications.
- Intraoperative adjunctive therapies provide an additional safety layer during CAS.
Objectives:
We have been performing preoperative coronary artery assessments and implementing coronary revascularization or intraoperative adjunctive therapies as needed in patients scheduled for carotid artery stenting (CAS) to prevent ischemic heart disease. In this study, we report the results of a retrospective observation of patients who underwent CAS under our treatment strategy to prevent perioperative coronary ischemic complications.
Methods:
A total of 224 cases from January 2014 to December 2021 were included. Following preoperative coronary artery CTA, preoperative coronary artery treatment or intraoperative adjunctive therapy (temporary transcutaneous cardiac pacemaker [TTCP] or intra-aortic balloon pumping [IABP]) was performed based on the degree of stenosis. We analyzed the outcomes of patients treated with CAS under this strategy at our institution.
Results:
Coronary artery disease was detected preoperatively in 143 cases (64%), with 91 cases (41%) indicated for coronary revascularization. Preoperative coronary artery treatment was performed in 76 cases (34%) prior to CAS, and adjunctive therapy with TTCP or IABP was provided in 28 cases (13%) during the procedure. No case developed perioperative coronary ischemic complication.
Conclusion:
In patients who have undergone CAS, perioperative coronary ischemic complications might be reduced by evaluating the risk of ischemic heart disease preoperatively, performing pre-CAS coronary artery intervention based on the severity of the lesions, and administering intraoperative adjunctive therapy.
