Hybrid one-day coronary artery bypass grafting and carotid artery stenting – cardiac surgeons’ perspective on the procedure’s safety

Introduction

Nowadays, patients scheduled for coronary artery bypass grafting (CABG) present with multiple comorbidities that may increase the incidence of complications and worsen the outcome. Concomitant and significant carotid stenosis is observed in around 8–14% of patients eligible for surgical myocardial revascularization [1]. In such cases, postoperative neurological complications and higher mortality are observed, especially in individuals with a history of prior stroke or transient ischemic attack (TIA) [2]. Currently, in patients qualified for CABG, prophylactic carotid revascularization should be considered in symptomatic cases and may be considered in asymptomatic ones after a multidisciplinary discussion [3]. Nevertheless, there are no strict guidelines regarding the timing and the modality of both procedures. Based on observational studies, combined 1-day hybrid intervention may reduce the interstage myocardial infarction (MI) rate observed in patients undergoing staged procedures [4, 5]. In spite of there being only a few available reports so far, this approach provides satisfactory early and long-term outcomes and could be considered as an especially attractive alternative for patients with advanced or unstable coronary artery disease, which results in high risk of cardiac complications during the carotid procedure [6, 7].

Aim

The aim of the study was to assess the surgical safety of one-day carotid artery stenting (CAS) combined with CABG.

Material and methods

In a retrospective cohort study we enrolled 57 consecutive patients (42 males, 15 females; mean age: 70.8 ±6.9 years) with a median EuroSCORE II of 2.4% (1.7–3.0) who were scheduled for hybrid one-day CAS combined with CABG based on a multidisciplinary Heart Team decision, including neurological and vascular consultations [3]. All patients required urgent (definitive procedure within the same hospitalization) cardiac surgery and had concomitant carotid artery stenosis qualifying them for revascularization (Table I A).
Carotid artery stenting was performed under local anesthesia through percutaneous transfemoral access using different embolic protection devices and different stent types according to the tailored CAS algorithm [8–10]. After the procedure, the patient was immediately transferred to the cardiac operating room, where additional neurological assessment was performed. In case of any focal deficits, the protocol assumed postponing the...


View full text...