The efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHI Tao , TENG Lequn , ZHANG Yongbao , FANG Jie , LI Jialiang ,  SHEN Chenyang

Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

SHEN Chenyang, Email: sancangszf@126.com

Keywords：

Carotid stenosis; coronary heart disease; carotid artery stenting; staged procedures

DOI：

10.7507/1007-4848.202210014

Video：

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Objective To evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. Methods The clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. Results A total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). Conclusion Staged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.

Citation： SHI Tao, TENG Lequn, ZHANG Yongbao, FANG Jie, LI Jialiang, SHEN Chenyang. The efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 1014-1019. doi: 10.7507/1007-4848.202210014 Copy

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10.	Paraskevas KI, Nduwayo S, Saratzis AN, et al. Carotid stenting prior to coronary bypass surgery: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2017, 53(3): 309-319.
11.	Guzman LA, Costa MA, Angiolillo DJ, et al. A systematic review of outcomes in patients with staged carotid artery stenting and coronary artery bypass graft surgery. Stroke, 2008, 39(2): 361-365.
12.	Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endovasc Surg, 2009, 37(4): 379-387.
13.	Müller MD, Gregson J, McCabe DJH, et al. Stent design, restenosis and recurrent stroke after carotid artery stenting in the international carotid stenting study. Stroke, 2019, 50(11): 3013-3020.
14.	de Vries EE, Meershoek AJA, Vonken EJ, et al. A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. J Vasc Surg, 2019, 69(6): 1952-1961.
15.	Fareed KR, Rothwell PM, Mehta Z, et al. Synchronous carotid endarterectomy and off-pump coronary bypass: An updated, systematic review of early outcomes. Eur J Vasc Endovasc Surg, 2009, 37(4): 375-378.
16.	Santarpino G, Nicolini F, De Feo M, et al. Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting. Eur J Vasc Endovasc Surg, 2018, 56(5): 741-748.
17.	Weimar C, Bilbilis K, Rekowski J, et al. Safety of simultaneous coronary artery bypass grafting and carotid endarterectomy versus isolated coronary artery bypass grafting: A randomized clinical trial. Stroke, 2017, 48(10): 2769-2775.
18.	Lescan M, Andic M, Bartos O, et al. Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: A retrospective study. BMC Cardiovasc Disord, 2020, 20(1): 303.
19.	Tzoumas A, Giannopoulos S, Charisis N, et al. Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis. Vascular, 2020, 28(6): 808-815.

1. Aboyans V, Lacroix P. Indications for carotid screening in patients with coronary artery disease. Presse Med, 2009, 38(6): 977-986.
2. Steinvil A, Sadeh B, Arbel Y, et al. Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease. J Am Coll Cardiol, 2011, 57(7): 779-783.
3. Naylor AR, Bown MJ. Stroke after cardiac surgery and its association with asymptomatic carotid disease: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2011, 41(5): 607-624.
4. Naylor AR. Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease? J Cardiovasc Surg (Torino), 2009, 50(1): 71-81.
5. Naylor AR, Ricco JB, de Borst GJ, et al. Editor's choice: Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
6. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
7. AbuRahma AF, Avgerinos ED, Chang RW, et al. Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg, 2022, 75(1S): 4S-22S.
8. 中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南. 中华血管外科杂志, 2022, 79(2): e21-e129.
9. Writing Committee Members, Lawton JS, Tamis-Holland JE, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2022, 79(2): e21-e129.
10. Paraskevas KI, Nduwayo S, Saratzis AN, et al. Carotid stenting prior to coronary bypass surgery: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2017, 53(3): 309-319.
11. Guzman LA, Costa MA, Angiolillo DJ, et al. A systematic review of outcomes in patients with staged carotid artery stenting and coronary artery bypass graft surgery. Stroke, 2008, 39(2): 361-365.
12. Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endovasc Surg, 2009, 37(4): 379-387.
13. Müller MD, Gregson J, McCabe DJH, et al. Stent design, restenosis and recurrent stroke after carotid artery stenting in the international carotid stenting study. Stroke, 2019, 50(11): 3013-3020.
14. de Vries EE, Meershoek AJA, Vonken EJ, et al. A meta-analysis of the effect of stent design on clinical and radiologic outcomes of carotid artery stenting. J Vasc Surg, 2019, 69(6): 1952-1961.
15. Fareed KR, Rothwell PM, Mehta Z, et al. Synchronous carotid endarterectomy and off-pump coronary bypass: An updated, systematic review of early outcomes. Eur J Vasc Endovasc Surg, 2009, 37(4): 375-378.
16. Santarpino G, Nicolini F, De Feo M, et al. Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting. Eur J Vasc Endovasc Surg, 2018, 56(5): 741-748.
17. Weimar C, Bilbilis K, Rekowski J, et al. Safety of simultaneous coronary artery bypass grafting and carotid endarterectomy versus isolated coronary artery bypass grafting: A randomized clinical trial. Stroke, 2017, 48(10): 2769-2775.
18. Lescan M, Andic M, Bartos O, et al. Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: A retrospective study. BMC Cardiovasc Disord, 2020, 20(1): 303.
19. Tzoumas A, Giannopoulos S, Charisis N, et al. Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis. Vascular, 2020, 28(6): 808-815.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis

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