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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
MANAGEMENT OF THE “POLYVASCULAR PATIENT”
Concomitant carotid and coronary artery disease
Carotid stenosis and concomitant coronary artery disease
Palombo G. 1, Stella N. 1, Faraglia V. 1, Rizzo L. 1, Capuano F. 2, Sinatra R. 2, Taurino M. 1
1 Division of Vascular Surgery, Sant’Andrea Hospital“La Sapienza” (Second Faculty) University of Rome, Rome, Italy
2 Division of Cardiac Surgery, Sant’Andrea Hospital “La Sapienza” (Second Faculty) University of Rome, Rome, Italy
Aim. Optimal strategy (staged or combined) for the treatment of patients with concurrent severe carotid and cardiac disease is still controversial. Moreover, carotid artery stenting (CAS), has become a valid alternative to carotid endarterectomy (CEA) and has been proposed for the treatment of cardiac patients. The authors report the preliminary results of a new therapeutic strategy consisting in combined CAS and cardiac surgery.
Methods. An initial series of 22 patients underwent combined CAS and cardiac surgery in the same operating room and under general anesthesia. All filter-protected CAS procedures were performed under only heparin and aspirin. A cervical approach (3-cm cervicotomy) was used in patients with documented vessel tortuosity or severe aorto-iliac occlusive arteriopathy. In all the other cases a femoral access was used. A double antiplatelet regimen was initiated in the early postoperative period, once major bleedings were excluded.
Results. Among the 22 patients who underwent this combined procedure, no deaths, no myocardial infarctions and one controlateral stroke (overall complication rate: 4.5%) were observed. This stroke was observed after transcervical CAS, coronary artery bypass and mitral valve replacement. No major postoperative bleedings nor stent thrombosis were observed.
Conclusion. Combined carotid stenting and cardiac surgery, performed in the same operating room under only heparin and aspirin, seems a safe and effective strategy for the treatment of patients with concomitant carotid and cardiac disease.