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Concomitant Versus Staged Percutaneous Cervicocerebral Artery Revascularization with Coronary Artery Bypass Grafting
Jinwei Zhang1,2, Liaoming He1,2, Chenzhen Xu1,2
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China.
Insights
This study compared simultaneous versus staged percutaneous cervicocerebral artery revascularization (PCAR) and coronary artery bypass grafting (CABG). Outcomes did not significantly differ, but more research is needed to confirm findings for severe carotid or vertebral artery stenosis.
Area of Science:
- Cardiovascular Surgery
- Interventional Neurology
- Vascular Medicine
Background:
- Optimal strategy for combining percutaneous cervicocerebral artery revascularization (PCAR) with coronary artery bypass grafting (CABG) is unclear.
- Patients often present with severe carotid or vertebral artery stenosis requiring intervention.
Purpose of the Study:
- To compare outcomes of concomitant versus staged PCAR-CABG.
- To evaluate the impact of the interval between staged procedures on patient outcomes.
Main Methods:
- Retrospective analysis of 801 patients undergoing PCAR-CABG.
- Comparison of concomitant (n=57) versus staged (n=744) interventions.
- Primary endpoint: perioperative death or stroke; analyzed using Firth penalized logistic regression.
Main Results:
- No significant difference in perioperative death or stroke between concomitant and staged PCAR-CABG (1.8% vs 5.0%).
- Exploratory analysis suggested a trend towards decreased risk with longer intervals between staged procedures.
- The 1-7 day staged group showed higher odds of adverse events compared to concomitant intervention.
Conclusions:
- Perioperative outcomes were similar for concomitant and staged PCAR-CABG in this cohort.
- Limited events prevent definitive conclusions on equivalence.
- Further prospective studies are required to validate interval-specific findings.
Introduction:
The optimal strategy and timing for percutaneous cervicocerebral artery revascularization (PCAR) combined with coronary artery bypass grafting (CABG) remain uncertain in patients with severe carotid or vertebral artery stenosis.
Methods:
We retrospectively analyzed adults undergoing concomitant or staged PCAR-CABG at Beijing Anzhen Hospital from January 2011 to December 2025. The primary endpoint was perioperative death or stroke. Strategies were compared using Firth penalized logistic regression. In the staged cohort, restricted cubic splines and interval-based analyses assessed the association between interprocedural interval and outcomes.
Results:
Among 801 patients, 57 (7.1%) underwent concomitant and 744 (92.9%) underwent staged intervention; the median interprocedural interval was 30 days (interquartile range, 9-46). PCAR was performed for severe vertebral stenosis in 221 (27.6%), severe carotid stenosis in 474 (59.2%), and both in 106 (13.2%). Perioperative death or stroke occurred in one patient (1.8%) in the concomitant group and 37 patients (5.0%) in the staged group. Concomitant intervention was not significantly associated with the primary endpoint after adjustment (adjusted odds ratio (OR) 0.43; 95% confidence interval (CI), 0.05-1.76; P = 0.280). Exploratory analyses suggested decreasing risk with longer intervals, although no significant nonlinear association was identified. The 1-7-day staged group had the highest estimated odds relative to the concomitant group (adjusted OR, 4.89; 95% CI, 1.04-48.30; P = 0.044).
Conclusions:
Perioperative death or stroke did not differ significantly between concomitant and staged PCAR-CABG. However, the limited number of events precludes conclusions regarding equivalence. Interval-specific findings were exploratory and require confirmation in adequately powered prospective multicenter studies.