Estratégia híbrida combinando angioplastia carotídea e cirurgia cardiovascular

Abstract

Hybrid Strategy Combining Carotid Stenting and Cardiovascular Surgery Background: Carotid lesions are observed in 8% to 14% of cardiovascular surgery candidates and increase the risk of perioperative stroke. This is particularly important in patients with coronary disease and/or severe valve disease who are not candidate to revascularization procedures at different time points. We assessed the results of a hybrid strategy, where carotid angioplasty and cardiovascular surgery were performed sequentially with an interval of a few hours. Method: Carotid lesions > 70% in symptomatic patients and > 80% in asymptomatic patients were treated. Acetylsalicylic acid was administered prior to carotid stenting and heparin was administered at the time of the procedure. Once the percutaneous intervention was over, patients were transferred to the surgery room to carry out the cardiovascular procedure. Clopidogrel was administered 8 hours after the end of the surgery. Results: Forty-three consecutive patients were included and treated with the hybrid strategy. Male patients (81%) were prevalent, with mean age of 70.5 ± 8.5 years, and 25.6% were diabetic. A cerebral protection system was used in 42 patients and stents were implanted in all of them. Coronary artery bypass graft (CABG) was performed in 20 patients, CABG + aortic valve replacement (AVR) in 18, CABG + ascending aorta repair in 1, CABG + mitral valve annuloplasty in 1, CABG + mitral valve replacement (MVR) in 1, AVR in 1 and MVR in 1. Hospital results showed 4 deaths (2 due to multiple organ failure, 1 due to heart failure and 1 to bleeding), 1 case of perioperative acute myocardial infarction and no strokes. Late followup was performed in all of the patients at 25 ± 15 months. After hospital discharge, there were two deaths not related to the percutaneous or surgical procedures and no neurological events. Conclusion: A hybrid strategy combining carotid stenting and cardiovascular surgery is feasible and safe with an acceptable complication rate. It may be a