Abstract
The outcome for simultaneous revascularization of more than 1 supra-aortic arterial stenosis has not been evaluated because of concerns regarding the increased risk of additional procedures. We evaluated the feasibility and safety of concomitant multiple supra-aortic arterial revascularizations (CMSAR). We retrospectively evaluated 50 consecutive patients who underwent CMSARs with angioplasty and stent placement. The study included a separate lesion group (LG) (n = 28), ipsilateral LG (n = 17) including adjacent (n = 6) and remote (n = 11) tandem lesions, and triple LG (n = 5). We assessed the procedural success (defined as residual stenosis <30%) and periprocedural event rate (ER) (minor or major stroke, and death). We compared the ERs in the lesion (ipsilateral vs separate) and symptom (unstable vs stable) pattern groups with the Fisher exact test. Procedural success was achieved in all patients (50/50). Periprocedural events within 30 days were noted in 5 (10%). ER within 2 days after the procedure was higher in the ipsilateral LG (4/17) than in the separate LG (0/28) (P = .016). Major events consisting of a major stroke and a death occurred in 2 patients in the unstable group (4%) and was more common in the unstable (2 of 7) than in the stable group (0/38) (P = .029). During the mean 11-month follow-up period, there was 1 symptomatic recurrence. CMSARs are feasible with a high procedural success rate resulting in a favorable short-term outcome. However, they must be carefully performed in ipsilateral LG, especially in patients in the unstable group.
Highlights
AND PURPOSE: The outcome for simultaneous revascularization of more than 1 supraaortic arterial stenosis has not been evaluated because of concerns regarding the increased risk of additional procedures
event rate (ER) within 2 days after the procedure was higher in the ipsilateral lesion group (LG) (4/17) than in the separate LG (0/28) (P ϭ .016)
concomitant multiple supra-aortic arterial revascularizations (CMSAR) are feasible with a high procedural success rate resulting in a favorable short-term outcome
Summary
We retrospectively evaluated 50 consecutive patients who underwent CMSARs with angioplasty and stent placement. We included patients who were symptomatic as having 1) severe stenosis in 2 separate supra-aortic vessels (n ϭ 28), 2) a remote tandem lesion when there were 2 stenotic lesions in different arterial segments in the same artery (n ϭ 11), 3) an adjacent tandem lesion when there were 2 stenotic lesions in the same arterial segment (n ϭ 6), 4) severe stenosis in 3 supra-aortic vessels (n ϭ 5), and asymptomatic patients as having 5) multiple supra-aortic stenoses noted before coronary artery bypass surgery (n ϭ 5). Among 45 patients who were symptomatic, 38 had stable symptoms that had resolved, or improving or stationary symptoms before the stent placement, and 7 patients had progressive (gradually worsening) or fluctuating symptoms with a change of more than 4 on the National Institutes of Health Stroke Scale (NIHSS). The patients’ ages ranged from 45 to 87 years
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