Sequential hybrid carotid and coronary artery revascularization: immediate and mid-term results.
BACKGROUND
To minimize event rates in patients with elevated cardiovascular surgical risk, we investigated a new therapeutic strategy consisting of simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG).


METHODS
The study included 37 patients with severe carotid and coronary artery disease and a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5 or higher. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, myocardial infarction, or death at 30 days. Secondary end points were a combination of transient ischemic attack, major local complications, bleeding, and systemic complications within the 30 days after treatment, and any stroke, acute myocardial infarction, or death from day 31 through to the end of the follow-up. All clinical outcomes were assessed by an independent monitoring board.


RESULTS
The rate of procedural success was 97.3%. The 30-day cumulative incidence of disabling stroke, myocardial infarction, or death was 8.1%: 2 patients (5.4%) died, and 1 patient had a stroke immediately after carotid stenting. Another patient died between day 31 and 6 months after the intervention.


CONCLUSIONS
Our findings indicate that in elevated-surgical-risk patients with carotid stenosis and coronary artery disease suitable for CABG, hybrid revascularization by CAS, immediately followed by CABG, is a feasible and promising therapeutic strategy.
Versaci
Francesco
F
Department of Cardiology, University of Tor Vergata, Rome, Italy.
Del Giudice
Costantino
C
Scafuri
Antonio
A
Zeitani
Jacob
J
Gandini
Roberto
R
Nardi
Paolo
P
Salvati
Alessandro
A
Pampana
Enrico
E
Sebastiano
Fabiano
F
Romagnoli
Andrea
A
Simonetti
Giovanni
G
Chiariello
Luigi
L
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology