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K. Dzierwa, J. Piatek, J. Konstanty-Kalandyk, P. Paluszek, L. Tekieli, M. Trystula, M. Michalski, R. Musial, K. Zmudka, P. Pieniazek, P4319
Carotid artery stenting simultaneous with urgent cardiac surgery as a revascularization method for patients with severe carotid and cardiac disease, European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx504.P4319, https://doi.org/10.1093/eurheartj/ehx504.P4319Close - Share Icon Share
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Purpose: Internal carotid artery (ICA) stenosis is a risk factor for stroke associated with cardiac surgery. Surgical revascularization (carotid endarterectomy combined with cardiac surgery) is of high perioperative complication rate. The aim of this study is to evaluate the role of carotid artery stenting (CAS) according to the 'tailored' algorithm, performed simultaneously with cardiac surgery as the less invasive therapeutic option.
Methods: From 2009 to 2016, 68 patients (age 70.6±6.7y, 75% male) with severe/symptomatic ICA stenosis coexisting with multivessel coronary artery disease or severe valve disease underwent hybrid procedure: CAS was immediately followed by cardiac surgery. Each patient was individually assessed in the vascular heart team. Most patients (58, 85%) had CSS class III or unstable angina symptoms, 7 (10%) were operated due to heamodynamically stable NSTEMI and 3 (4.4%) with severe valve disease had recent pulmonary oedema. Neurologically symptomatic ICA stenosis (stroke or transient ischemic attack within 6 preceding months) was present in 18 (26%) patients. Mean ICA stenosis rate was 85.6±9.2%, range 60–99% and 16 (23%) patients had subtotal 95–99% ICA stenosis. CAS procedures were performed according to the 'tailored' strategy – to fit proper neuroprotection (proximal or distal) and stent (open or closed-cell) type to the ICA lesion severity, morphology and neurological symptom status of the patient. Neuroprotection devices were mandatory for all CAS procedures. Proximal neuroprotection type was used in 30 (44%) patients and closed cell stent was implanted in 64 (94%) patients. CAS was performed on acetylsalicylic acid and heparin. Clopidogrel (loading dose of 300 mg) was administered in the early postoperative period (6–10 hours), after surgical bleedings were excluded and continued at daily dose of 75 mg for at least a month. Operation risk according to euroSCORE was 2.7±1.4% (range 0.95–6.91%). Isolated coronary artery bypass grafting (CABG) was done in 61 (89.7%) cases, isolated valve surgery was performed in 4 (6%) patients and the rest were combined procedures. Most procedures (52, 76%) were done on normothermic cardiopulmonary bypass. Mean surgical drainage was 615±372, range 160–1800 ml.
