Carotid Artery Stenting before CABG: A Better Alternative to Treat Concomitant Coronary and Carotid Artery Disease
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Keywords
coronary artery bypass graft, coronary artery disease, carotid stenosis, outcome
Abstract
Background: Atherosclerosis of the coronary and carotid arteries can be fatal. Stroke is a serious complication of coronary artery bypass graft surgery, and carotid artery dysfunction is a major risk factor for stroke (CABG).
Methods: Patients who met the criteria for CABG were included in this prospective cohort study of those with severe carotid artery stenosis (>70%). Complications 30 days after stenting, neurological complications during cardiac surgery, rates of myocardial infarction (MI), and rates of death were among the outcome indicators evaluated.
Results: according to outcome the mean duration of follow-up was 31.23 (±18.27 SD) with range (1-60) months, according to early adverse event there were 1 (0.5%) with cardiac death, 1 (0.5%) with major Ipsilateral Nonfatal Strokes, 2 (1%) with minor strokes, there were 30 cases of cardiac death (15%), 2 cases of neurological death (1%), 4 cases of death for other reasons (2%), 2 cases of major ipsilateral nonfatal stroke (1%), 1 case of major contralateral nonfatal stroke (0.5%), 10 cases of minor ischemic stroke (5%), 12 cases of transient ischemic attack (2%), and 2 cases of nonfatal myocardial infarction (1%).
Conclusion: Patients with concurrent carotid and coronary artery disease may benefit from both hybrid revascularization by CAS-CAB and phased revascularization by CAS-CAB, which are feasible, safe, and provide good short- and long-term results. Our research suggests that CAS should be considered as a feasible alternative to open heart surgery. An adequately powered randomised experiment should compare the two approaches.
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