open access
Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery
open access
Abstract
Background: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.
Methods: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.
Results: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1–144 months), there were no new neurological deficits, while one additional death occurred.
Conclusions: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.
Abstract
Background: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery.
Methods: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery.
Results: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1–144 months), there were no new neurological deficits, while one additional death occurred.
Conclusions: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.
Keywords
carotid arterial disease, carotid angioplasty, cardiac surgery
About this articleTitle
Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery
Journal
Issue
Pages
25-30
Published online
2015-02-24
Page views
2402
Article views/downloads
1457
DOI
10.5603/CJ.a2014.0001
Pubmed
Bibliographic record
Cardiol J 2015;22(1):25-30.
Keywords
carotid arterial disease
carotid angioplasty
cardiac surgery
Authors
Oscar A. Mendiz
Carlos M. Fava
Gustavo A. Lev
León R. Valdivieso
Gaspar Caponi
Gustavo F. Hidalgo Alava
Roberto R. Favaloro
