Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass grafting: the SHARP study.
OBJECTIVE
In an attempt to reduce post-operative events we investigated a new therapeutic strategy consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by an on-pump coronary artery bypass graft (CABG).


BACKGROUND
Preventing stroke and cardiovascular events after coronary artery revascularization in patients with elevated surgical risk is a complex and multifaceted problem.


METHODS
One hundred-one consecutive patients with severe carotid and coronary artery disease and a standard EuroSCORE >or=5 were included in this multicenter study. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, acute myocardial infarction (AMI), or death at 30 days. Secondary outcomes were transient ischemic attacks; major local complications; bleeding and systemic complications within 30 days after treatment; and any stroke, AMI, or death occurring from the 31st day to the end of the 12-month follow-up. All clinical outcomes were assessed by an independent monitoring board.


RESULTS
The rate of procedural success was 98%. The 30-day cumulative incidence of disabling stroke, AMI, or death was 4%: 2 patients died (2%) in the post-operative period, and 2 patients (2%) had a stroke immediately after CAS and before CABG. Three patients died from the 31st day to the 12th month after the procedure.


CONCLUSIONS
Our findings indicate that in high-risk patients with coronary artery disease suitable for CABG and carotid artery disease, the hybrid revascularization by CAS immediately followed by CABG is a promising and feasible therapeutic strategy.
Versaci
Francesco
F
Divisione di Cardiologia, Università Tor Vergata, Rome, Italy.
Reimers
Bernhard
B
Del Giudice
Costantino
C
Schofer
Joachim
J
Giacomin
Alessandro
A
Saccà
Salvatore
S
Gandini
Roberto
R
Albiero
Remo
R
Pellegrino
Antonio
A
Bertoldo
Fabio
F
Simonetti
Giovanni
G
Chiariello
Luigi
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002339:Carotid Arteries; D002340:Carotid Artery Diseases / Q000188:drug therapy / Q000628:therapy*; D000077144:Clopidogrel; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000473:pathology* / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine