ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2018 December;25(4):283-7

DOI: 10.23736/S1824-4777.18.01371-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Safety of carotid endarterectomy early after percutaneous coronary interventions

Raoul BORIONI ¹ ✉, Fabrizio TOMAI ², Giovanni DE PERSIO ², Laura FRATTICCI ¹, Maria C. TESORI ¹, Carolina PACIOTTI ¹, Mariano GAROFALO ¹

¹ Department of Vascular Surgery, Aurelia Hospital, Rome, Italy; ² Department of Cardiology, Aurelia Hospital, Rome, Italy

BACKGROUND: Large published studies regarding the outcome of carotid endarterctomy (CEA) in patients recently treated with percutaneous coronary interventions (PCI) and on dual antiplatelet therapy (DAPT) are lacking. This study sought to evaluate the safety of CEA in this clinical setting.
METHODS: Between January 2012 and December 2017, 52 consecutive patients were treated with CEA after recent (≤40 days) PCI and enrolled in this prospective registry. Forty-one consecutive patients with a history of coronary artery disease and non-recent PCI undergoing CEA in the same period of time were identified as control group. The primary endpoint of the study was the 30-day incidence of major adverse cardiac and cerebrovascular events (MACCE), including any death, myocardial infarction, or stroke. Secondary endpoints were cervical complications, defined as major bleeding and cranial nerve injuries.
RESULTS: The majority of patients undergoing CEA was treated with drug-eluting stent implantation (92.3%) 21.4±11.5 days before (range 1 to 40 days) and was on DAPT. The incidence of the primary endpoint at 30 days was 3.8% (95% confidence interval [CI]: 2 to 9.6). The rate of death, myocardial infarction, and stroke was 0%, 1.9% and 3.8% respectively. The incidence of major bleedings and cranial nerve injuries were 1.9% and 3.8% respectively. The control group resulted comparable in terms of age, gender and risk factors, and exhibited similar outcome. Specifically, the incidence of MACCE, major bleedings and nerve injuries at 30 days was 4.8%, 2.4% and 2.4%, respectively (all P>0.05).
CONCLUSIONS: In this early investigation, CEA performed in patients recently treated with PCI and on DAPT is safe with low incidence of bleedings. These results, if confirmed in larger and multicentric studies, may help to simplify the treatment strategy of patients with severe carotid obstructive disease and concomitant coronary artery disease.

KEY WORDS: Endarterectomy, carotid - Percutaneous coronary interventions - Platelet aggregation inhibitors