Comparison of results of staged and hybrid approaches in surgical treatment of patients with coronary heart disease and cerebrovascular disease

Abstract

We compared the immediate outcomes of hybrid procedure and step-by-step internal carotid artery (CA) stenting and coronary artery bypass grafting (CABG) in high-risk surgical patients with combined lesions of coronary and carotid vasculature. The indications for hybrid surgery were identified. 50 patients with combined lesions of the coronary bed and the carotid vasculature were divided into two groups. The 1st group had 30 patients (60%), who first underwent CA stenting followed by CABG. The 2nd group included 20 patients (40%), who underwent hybrid procedures (simultaneous CA stenting and CABG). Patients with atherosclerosis of aortoiliac and femoropopliteal segments (p <0.0001) were by far more frequent in the hybrid procedures group. The 1st group was found to have no fatal outcomes. 3 patients (10%) experienced cerebral stroke. The hybrid procedures group had no deaths and cerebral stroke patients. 2 patients developed a myocardial infarction. None of the above indices was found to have statistically significant differences between the groups (р >0.05). On average, the patients of the 1st group were in the Intensive Care Unit (ICU) for 2.91.9 days; the patients of the 2nd group stayed in the ICU for 3.96.4 days (р = 0.42). The average postoperative hospital stay for the 1 st group patients amounted to 10.84.5 days, while that for the 2nd group patients was equal to 10.85.8 days (р = 1). The groups were found to have no statistically relevant differences of complication risks, the length of ICU stay, and the total number of days spent in hospital. If patients with combined lesions of the coronary artery and the carotid artery also suffer from critical lower-extremity stenosis, a hybrid procedure allows surgeons to perform CA stenting.