Revascularization by carotid artery stenting and off-pump coronary artery bypass.
BACKGROUND
The optimal management of patients with concomitant carotid and coronary artery disease remains controversial currently. The purpose of this study was to evaluate the safety and efficacy of hybrid or staged revascularization by carotid artery stenting (CAS) and off-pump coronary artery bypass (OPCAB) in the treatment of these patients.


METHODS
From September 2006 to January 2011, 59 consecutive patients with carotid and coronary artery disease underwent either hybrid (n = 20) or staged (n = 39) CAS and OPCAB, the perioperative and long-term outcomes were analysed. The primary endpoint was the incidence of stroke, perioperative myocardial infarction (MI) or death within 30 days of the procedures.


RESULTS
No death occurred post-operatively. Two patients (2/20) in hybrid group and two patients (2/39) in staged group suffered from non-fatal stroke. The combined incidence of stroke, MI or death at 30 days was 10.0% in hybrid group and 5.1% in staged group (P = 0.875). The median follow-up time was 44 months (range, 28 to 80 months) with 57 patients (96.6%) available. During follow-up period, one patient had non-fatal stroke in hybrid group and one patient suffered from MI in staged group, respectively. There was no significant difference of long-term event-free survival between the two groups (log-rank test, P = 0.390).


CONCLUSIONS
Our findings demonstrate that for patients with carotid and coronary artery disease, both hybrid and staged revascularization by CAS and OPCAB are feasible and safe therapeutic strategies with good early and long-term outcomes. However, our results have to be substantiated by larger scale studies and randomized trials.
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Tao
T
Yang
Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Tsinghua University, Beijing, China.
Lefeng
L
Zhang
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Xianqiang
X
Wang
Department of Interventional Cardiology, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Hui
H
Dong
Department of Interventional Cardiology, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Xiongjing
X
Jiang
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Hansong
H
Sun
D000368:Aged; D001807:Blood Vessel Prosthesis; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
carotid artery stent; off-pump surgery; revascularization