A new research showed that patients with high risk of carotid and coronary disease have a feasibility treatment with carotid artery stenting (CAS) immediately following by on-pump coronary artery bypass grafting (CABG).
Earlier studied have seen that 49% of deaths in patients undergoing carotid endarterectomy are due to cardiac causes. On the contrary, patients undergoing CABG, the co-existence of severe carotid disease greatly increases the risk of perioperative stroke, according to a report.
According to the report, performing a carotid endarterectomy first and following up by CABG days to weeks later can reduce the risk of stroke during CABG. But the risk of MI during the carotid procedure and leading up to the CABG is relatively high.
In the SHARP (Simultaneous Hybrid Revascularization by CAS and CABG) study, Dr. Francesco Versaci, from Universita Tor Vergata, Rome, and colleagues evaluated the feasibility of the combined CAS/CABG approach in 101 consecutive patients with severe carotid and coronary disease.
The carotid stenting procedure was performed under local anesthesia, and then the patients were transferred directly to OR for the coronary bypass operation. The procedural success rate was 98%, the report indicates.
The main outcome measure was the 30-day rate of stroke, MI, or death. The rate of the combined endpoint was 4%. This included two patients who died in the postoperative period and two who had a stroke between CAS and CABG. Three additional deaths occurred by 12 months of follow-up.
By comparison, combined stroke/death rates of about 11% have been reported when carotid endarterectomy has been combined with CABG, the authors note.
Dr. John G. Byrne, from The Vanderbilt Heart and Vascular Institute in Nashville, Tennessee, and team reported the difficulty is in determining which patients benefit from carotid endarterectomy vs. CAS prior to CABG and if use of off-pump CABG can further reduce complications.