title: Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery.
abstract: BACKGROUND
  Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.
  
  
  METHODS
  From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.
  
  
  RESULTS
  There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1-144 months), there were no new neurological deficits, while one additional death occurred.
  
  
  CONCLUSIONS
  In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.
authors: Department of Interventional Cardiology, University Hospital Favaloro Foundation, Buenos Aires, Argentina. omendiz@ffavaloro.org.
authors: Oscar A
authors: OA
authors: Mendiz
authors: Carlos M
authors: CM
authors: Fava
authors: Gustavo A
authors: GA
authors: Lev
authors: León R
authors: LR
authors: Valdivieso
authors: Gaspar
authors: G
authors: Caponi
authors: Gustavo F
authors: GF
authors: Hidalgo Alava
authors: Roberto R
authors: RR
authors: Favaloro
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000077144:Clopidogrel; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006493:Heparin / Q000008:administration & dosage; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin