title: One stage carotid artery stenting and open heart surgery: a novel approach.
abstract: OBJECTIVE
  The optimal management of the patients requiring cardiac surgery with simultaneous severe carotid disease remains controversial. The traditional approach involves staged or combined carotid endarterectomy and cardiac surgery. This study evaluated the feasibility and safety of angioplasty and stenting for the treatment of carotid stenoses combined with cardiac operations in order to reduce the risk of perioperative stroke.
  
  
  METHODS
  In a prospective, non-randomized study, we analyzed 70 consecutive patients requiring cardiac surgery with simultaneous severe carotid artery disease that underwent carotid artery stenting (CAS) and cardiac surgery in one stage. Symptomatic patients with ≥ 60% carotid stenosis, and asymptomatic patients with ≥ 70% stenosis, were treated using CAS under local anesthesia immediately before the open heart surgery. Cerebral protection devices were used in all cases.
  
  
  RESULTS
  Despite the high baseline risk profile, our results were very encouraging. Carotid stenting was successful in all patients. No neurological complications occurred during the carotid stenting procedures. The 30-day death/stroke rate was 1.4% (no deaths, 1 contralateral minor stroke). No myocardial infarctions occurred. The carotid restenosis rate was zero during the long-term follow up.
  
  
  CONCLUSIONS
  The low complication rate suggests that CAS and cardiac surgery in one stage offers a safer therapeutic option compared to combined carotid endarterectomy and cardiac surgery. It may also be safer than with the staged CAS and coronary artery bypass grafting approach as well.
authors.affiliation: Department of Cardiovascular Surgery, Kyanous Stavros Hospital, Thessaloniki, Greece. i-e@otenet.gr
authors.forename: I
authors.initials: I
authors.lastname: Velissaris
authors.forename: D
authors.initials: D
authors.lastname: Kiskinis
authors.forename: K
authors.initials: K
authors.lastname: Anastasiadis
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006115:Greece; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color