Endovascular carotid artery stenting and early coronary artery bypass grafting for asymptomatic carotid artery stenosis: long-term outcomes and neurologic events.
BACKGROUND
Optimal management of patients with asymptomatic critical carotid artery stenoses prior to coronary artery bypass grafting (CABG) has no clear consensus. Further, optimal timing for surgical coronary revascularization has not been defined after or with any carotid revascularization.


METHODS
We reviewed the data from 2002 to 2007, of all patients in our institution who underwent carotid artery stenting (CAS) for critical carotid artery stenoses, prior to CABG. Twenty patients with critical carotid disease were referred for preoperative carotid intervention prior to CABG. Carotid duplex demonstrated evidence of critical stenoses in all patients. Patients were serially assessed by a stroke neurologist before and after the procedure (immediately, at 24 hr, at 48 hr, immediately following CABG, and at 30 days). We evaluated initial procedural success as well as freedom from periprocedure stroke.


RESULTS
Prior to undergoing CABG, 20 patients had stents placed in a single carotid artery for unilateral asymptomatic critical carotid artery stenoses. All the procedures, except one, were performed with distal embolic protection. Patients received aspirin and clopidogrel. There were no strokes or deaths up to a mean follow up of 486 days. The mean time from CAS to CABG performed in the same hospital admission was 6.4 days. Transfusion rates were not excessive despite dual antiplatelet therapy.


CONCLUSIONS
In a real-world setting, endovascular extracranial CAS for asymptomatic carotid artery stenosis by experienced operators, prior to CABG was safe and permitted early coronary revascularization without increased risk of strokes or death in this high-risk cardiovascular patient population.
Ranaweera
Priyantha S
PS
Division of Interventional Cardiology and Vascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Bigelow
Brian C
BC
Leary
Megan C
MC
de la Torre
Ralph
R
Sellke
Frank
F
Garcia
Lawrence A
LA
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001803:Blood Transfusion; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D010975:Platelet Aggregation Inhibitors