A Direct Comparison of Early and Late Outcomes With Three Approaches to Carotid Revascularization and Open Heart Surgery

Abstract

Staged CAS-OHS and combined CEA-OHS are associated with a similar risk of death, stroke, or MI in the short term, with both being better than staged CEA-OHS. However, the outcomes significantly favor staged CAS-OHS after the first year.

2018 ESC/EACTS Guidelines on myocardial revascularization

“…Up to 40% of NSTE-ACS patients with obstructive CAD present with multiple complex plaques [159][160][161][162] and 25% with an acute occluded coronary artery, 163 so that identification of the culprit lesion may be challenging. Correlation with ECG or echo changes and the use of OCT in the 25% of NSTE-ACS patients with angiographically normal epicardial coronary arteries [164][165][166] may be helpful for identifying the culprit lesion, or rule out other mechanisms such as dissection or haematomas [MI with non-obstructive coronary arteries (MINOCA)].…”

Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A Randomized Clinical Trial

“…24 More recent observational studies have even favored CAS before CABG. 20,25,26 However, dualantiplatelet therapy is mandated for at least 4 weeks after CAS, which for many surgeons constitutes a reason to postpone CABG because of the risk of bleeding, exposing a patient to an additional risk of myocardial infarction. Whether asymptomatic high-grade carotid artery stenosis unrelated to CABG requires revascularization is the subject of ongoing studies (SPACE- Our trial has several limitations.…”

Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery

“…Subsequently, staged CAS-OHS experienced significantly fewer late hazard phase events in comparison to both staged CEA-OHS Thirty days and one year death and stroke rates were similar but CAS group had a lower myocardial infarction rate and better evolution [12].…”

“…In a recent publication from Shishehbor et al [12], the authors analized 350 patients who received 3 different strategies: staged CEA and OHS (n = 45), combined CAE plus OHS (n = 195) and staged CAS plus OHS (n = 110). The time between CEA and OHS was as soon as possible according to clinical condition, while for CAS and OHS it was 4 weeks and 5 additional days after clopidogrel was stopped.…”