Safety and effectiveness of combining carotid artery stenting with cardiac surgery: preliminary results of a single-center experience.
OBJECTIVE
Optimal strategy (staged or combined) for the treatment of patients with concurrent severe carotid and cardiac disease is still controversial. Moreover, carotid artery stenting (CAS), has become a valid alternative to carotid endarterectomy (CEA) and has been proposed for the treatment of cardiac patients. The authors report the preliminary results of a new therapeutic strategy consisting in combined CAS and cardiac surgery.


METHODS
An initial series of 22 patients underwent combined CAS and cardiac surgery in the same operating room and under general anesthesia. All filter-protected CAS procedures were performed under only heparin and aspirin. A cervical approach (3-cm cervicotomy) was used in patients with documented vessel tortuosity or severe aorto-iliac occlusive arteriopathy. In all the other cases a femoral access was used. A double antiplatelet regimen was initiated in the early postoperative period, once major bleedings were excluded.


RESULTS
Among the 22 patients who underwent this combined procedure, no deaths, no myocardial infarctions and one controlateral stroke (overall complication rate: 4.5%) were observed. This stroke was observed after transcervical CAS, coronary artery bypass and mitral valve replacement. No major postoperative bleedings nor stent thrombosis were observed.


CONCLUSIONS
Combined carotid stenting and cardiac surgery, performed in the same operating room under only heparin and aspirin, seems a safe and effective strategy for the treatment of patients with concomitant carotid and cardiac disease.
Palombo
G
G
Division of Vascular Surgery, Sant'Andrea Hospital La Sapienza, Second Faculty, University of Rome, Rome, Italy. giovanni.palombo@tiscali.it
Stella
N
N
Faraglia
V
V
Rizzo
L
L
Capuano
F
F
Sinatra
R
R
Taurino
M
M
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin