[Value of percutaneous carotid angioplasty before cardiac surgery]

Transluminal angioplasty (TLA) of asymptomatic carotid stenoses (> 85%) in patients candidates for coronary artery bypass graft for stable angina appears to be an interesting technique to evaluate in a population whose management is controversial. Between January 1993 and January 1995, 10 patients underwent Carotid TLA (CTLA) prior to coronary artery bypass grafts (mean: 17.4 days). The mean age was 71 +/- 4.3 years. Eight patients were classified as NYHA class II and two were classified as class III. The mean number of bypass grafts per patient was 2.7. Four patients presented contralateral thrombosis of the internal carotid artery. CTLA was performed under cerebral protection by means of a triple coaxial catheter. Six CTLA required a Strecker stent. The mean follow-up was 11.4 months, with no mortality. One patient presented with transient hemianopsia. All patients were reviewed at 4 months by follow-up angiography, followed by Doppler. Only one of the 10 patients reviewed required redilatation with complementary stenting and another patient required dilatation of the stent. Although the follow-up of this short series is brief, the results of CTLA are encouraging in this population with a high risk of morbidity and mortality (elderly patients, frequently bilateral carotid lesions, coronary bypass grafts with multiple arterial grafts.