Non-protected carotid artery stent without angioplasty in high-risk patients with carotid and coronary artery disease undergoing cardiac surgery

Abstract

Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or carotid artery stenting (CAS), often not well tolerated in patients with coronary artery disease. The purpose of this study is to assess whether CAS without angioplasty is beneficial in patients with severe carotid artery disease before coronary revascularization surgery (CABG) regarding the occurrence of HD. Between October 2002 and August 2006, 39 CAS were performed in 35 patients before cardiac surgery. Outcome measures, including periprocedural and 30-day post stenting and cardiac surgery complications, were assessed. Twenty-seven patients underwent CABG and eight combined CABG and valve replacement. During or immediately after CAS there was no episode of bradycardia or hypotension necessitating medical treatment. In the period between CAS-CABG, there was no case of HD. We also found no myocardial infarction. There were five neurological complications, two of them in the period between CAS-CABG (one transitory ischemic attack (TIA) and one minor stroke) and three after CABG (one TIA and two strokes). Three of them were discharged symptom-free. CAS without angioplasty can be a safe alternative to treat patients with coexistence of carotid and cardiac disease, since does not produce hemodynamic depression, therefore diminishing the cardiac complications.

Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

“…This effect was also observed by Rebellino et al (Rabellino et al, 2010). This factor may contribute to shorter hospitalizations and increased periprocedural safety.…”

Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic Review and Meta-Analysis

“…13,15e19,21,23,33e40 In previously symptomatic patients, the stenosis threshold for performing CAS þ CABG was 50% in six studies, 30,31,35,36,39,40 especially if the patient had a contralateral occlusion. 27 The threshold was 60% in three studies 19,20,29 and 70% in 11 studies, 14,17,18,23e25,27,32e34,38 while Guerra et al 37 adopted >80% as the threshold for intervening in previously symptomatic patients.…”

“…Carotid stenosis thresholds for performing CAS þ CABG varied considerably across the constituent studies. In asymptomatic patients, the stenosis threshold for performing CAS was 50% in the presence of a contralateral occlusion in one study, 27 while Gross et al 20 adopted a threshold of *Of these 520 non-English reports, 147 were in German, 108 in Chinese, 120 in Japanese, 57 in Russian, 38 in French, 37 in Spanish and 13 in other language (e.g. Croatian, Bulgarian, etc.)…”

A Systematic Review of Early Results Following Synchronous or Staged Carotid Artery Stenting and Coronary Artery Bypass Grafting

“…In the staged group, three studies 24,27,28 used only aspirin before the CAS procedure, eight studies 10,13,22,25,26,[29][30][31] recommended dual-antiplatelet strategy (aspirin þ clopidogrel) and two 12,23 had no clear information. The duration of dual-antiplatelet strategy varied from 3 to 5 days.…”