The effectiveness of endovascular revascularization of the carotid basin performed before coronary artery bypass grafting in patients with combined atherosclerotic lesions of cerebral and coronary arteries

Keywords: carotid stenting; coronary artery bypass grafting.

Abstract

Objective – to determine the effectiveness of endovascular revascularization of the carotid pool (carotid stenting) in patients with combined atherosclerotic lesions of the cerebral and coronary arteries, which showed coronary artery bypass grafting (CABG).
Materials and methods. 40 patients with combined atherosclerotic lesions of the cerebral and coronary arteries were included in the study. All patients for 14 days before CABG were stented carotid artery. The number of complications and the treatments results were determined. Survival functions were determined to evaluate long-term treatment outcomes over a 10-year follow-up period. Results. 32.5 % of patients had complications after carotid pool revascularization: angina pectoris – 12.5 %, acute myocardial infarction – 2.5 %, transient ischemic attack – 12.5 %, ischemic stroke – 2.5 %, arterial hypotension – 2.5 %. 98.2 % of patients observed positive results of treatment for neurological status. After revascularization of the coronary pool, 45 % of patients had complications: angina – 27.5 %, cardiac arrhythmia – 27.5 %, acute myocardial infarction – 2.5 %, transient ischemic attack – 7.5 %, ischemic stroke – 7.5 %. 83.5 % of patients received positive results of treatment. The 10-year survival rate after surgery was 19 % [34 %; 7 %]. Decrease in survival function was observed uniformly throughout the observation period: 3-year survival – 83 % [92 %; 67 %], 5-year survival – 56 % [70 %; 39 %].
Conclusions. Positive results of treatment in patients with combined atherosclerotic lesions of the cerebral and coronary arteries, which performed stenting of the carotid arteries before CABG, are observed in 98.5 % of patients. Carotid artery stenting before CABG is an effective method of preventing cerebral complications in the early postoperative and distant periods. Long-term results of treatment are accompanied by low rates of 5-year and 10-year survival after revascularization of the carotid and coronary pools.

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References

Paraskevas KI, Nduwayo S, Saratzis AN, Naylor AR. Carotid stenting prior to coronary bypass surgery: an updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2017 Mar;53(3):309-19. PMID: 28094166 DOI: 10.1016/j.ejvs.2016.12.019

Visconti G, Marino L, Briguori C. Simultaneous hybrid revascularization by bilateral carotid stenting and coronary artery bypass grafting. Catheter Cardiovasc Interv. 2014 Feb;83(2):E155-8. PMID: 21207421 DOI: 10.1002/ccd.22880

Drozhzhin EV, Ibragimov OR, Kovalchuk DN i dr. Gibridnaja operacija pri sochetannoj arterialnoj patologii. Angiologija i sosudistaja hirurgija. 2013;19(2): 59-63. (in Russian)

Repossini A, Rojtberg GE, Kotelnikov IN, Sokolov DV. Gibridnaja revaskuljarizacija: kombinirovannyj podhod pri mnogososudistom porazhenii koronarnyh arterij. Kardiologija. 2013;53(9):62-7. (in Russian)

Nikulnikov PI, Gabrijeljan AV, Ratushnjuk AV ta in. Dosvid hirurgichnogo likuvannja pacijentiv z pojednanym aterosklerotychnym urazhennjam koronarnyh ta sonnyh arterij. Visnyk Vinnyckogo nacionalnogo medychnogo universytetu. 2017;21(2):445-7. (in Ukrainian)

Zhang J, Xu RW, Fan X, Ye Z, Liu P. A systematic review of early results following synchronous or staged carotid artery stenting and coronary artery bypass grafting. Thorac Cardiovasc Surg. 2017 Jun;65(4):302-10. PMID: 26536085 DOI: 10.1055/s-0035-1566262

Feldman DN, Swaminathan RV, Geleris JD et al. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv. 2017 Feb 13;10(3):286-98. PMID: 28183469 DOI: 10.1016/j.jcin.2016.11.032

Hosmer D, Lemeshow S, May S. Applied survival analysis: Regression modeling of time-to-event data. 2nd ed. New York: John Wiley & Sons, 1999. 416 p.

Filardo G, Hamilton C, Grayburn PA et al. Established preoperative risk factors do not predict long term survival in isolated coronary artery bypass grafting patients. Ann Thorac Surg. 2012;93(6):1943-8. PMID: 22560263 DOI: 10.1016/j.athoracsur.2012.02.072


Abstract views: 24
PDF Downloads: 18
Published
2020-07-07
How to Cite
Grigoruk, S. (2020). The effectiveness of endovascular revascularization of the carotid basin performed before coronary artery bypass grafting in patients with combined atherosclerotic lesions of cerebral and coronary arteries. Endovascular Neuroradiology, 31(1), 14-18. https://doi.org/10.26683/2304-9359-2020-1(31)-14-18