Simultaneous Carotid Artery Stenting and Heart Surgery: Expanded Experience of Hybrid Surgical Procedures

Abstract

The aim of this study was to evaluate 10-year results of same-day hybrid revascularization of concomitant carotid artery disease by stenting (CAS) and coronary artery disease by coronary artery bypass grafting (CABG), later also applied to patients requiring CAS and other than coronary open heart cardiac surgery. One hundred thirty-two consecutive patients (70 ± 8 years, 102 men) underwent same-day CAS and CABG (group 1, n= 97) or other cardiac surgical procedures (aortic ± mitral valve surgery ± ascending aorta replacement ± CABG; group 2, n= 35). In both groups aspirin (100 mg daily) was started 2 days before CAS and permanently continued; clopidogrel, 300 mg initially followed by 75 mg daily, was started 6 hours after surgery and discontinued 1 month later. In group 2, when required, warfarin was started and aspirin discontinued on the second postoperative day. Mean follow-up was 53 ± 24 months. Overall in-hospital mortality was 3.8% (2.1% in group 1 versus 8.6% in group 2; p= 0.02; 0% for noncoronary isolated procedures, 20% for complex cases), perioperative myocardial infarction was 0%, and stroke was 0.75% (0% in group 1 versus 2.86% in group 2; p= 0.26). Late survival was 81% ± 10% (92% ± 3.2% in group 1 versus 80% ± 11% in group 2; p= 0.45), and overall freedom from neurologic events was 84% ± 6%. Same-day hybrid approach appeared safe in terms of early and long-term results not only for CAS and isolated CABG but also for CAS and noncoronary isolated procedures. In complex cases, the rate of stroke and myocardial infarction seemed low; in-hospital mortality, as expected, was higher. Long-term survival appeared similarly satisfactory, thus confirming the hybrid approach as a valid therapeutic option for all patients with significant internal carotid artery stenosis associated with coronary and other cardiac lesions, at least for noncomplex cases.