Is there any benefit from staged carotid and coronary revascularization using carotid stents? A single-center experience highlights the need for a randomized controlled trial.
OBJECTIVE
To assess the benefits of carotid artery stenting before coronary artery bypass surgery to reduce the risk of stroke occurring during the cardiac procedure.


METHODS
A prospective cohort study was performed in patients undergoing carotid artery stenting before coronary artery bypass surgery, or combined bypass and valve replacement procedures, to assess the procedures effectiveness in stroke prevention. Outcome measures including 30-day post stenting and cardiac surgery neurological complication and all-cause mortality rates were assessed.


RESULTS
A total of 52 patients were included. Two patients underwent aortic valve replacements at the same time as coronary revascularization. No neurological complications occurred because of the stenting procedure. One cardiac death not related to coronary artery bypass surgery occurred in the 30-day follow-up period for the stent procedure. An additional 6 (11.5%) outcome events (3 strokes and 3 deaths) occurred in the 30-day follow-up period after the cardiac procedure. Three patients died of cardiac causes while awaiting their cardiac bypass procedure.


CONCLUSIONS
Our results are comparable to those in patients that undergo staged or combined carotid endarterectomy before cardiac surgery. Our small cohort study adds to the limited world literature on the subject but is not sufficiently powered to recommend alterations in practice.
Randall
Marc S
MS
Neurology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom. m.randall@tiscali.co.uk
McKevitt
Fiona M
FM
Cleveland
Trevor J
TJ
Gaines
Peter A
PA
Venables
Graham S
GS
D000368:Aged; D017130:Angioplasty / Q000379:methods; D001011:Aorta / Q000473:pathology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006351:Heart Valves; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012107:Research Design; D015607:Stents; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome