Key result
Staged and simultaneous approaches for CAD and carotid stenosis show similar hospital mortality.
Why the study?
Surgical strategies for patients with coronary artery disease and concomitant brachycephalic artery stenosis remain uncertain, with the advantages of various techniques still debated.
Does staged surgical intervention compared to simultaneous intervention improve hospital mortality and complications in patients with CAD and concomitant BCA atherosclerosis?
Cohort (n=574)
No
Does staged surgical intervention compared to simultaneous intervention improve hospital mortality and complications in patients with CAD and concomitant BCA atherosclerosis?
Absolute Event Rate: 0.2% vs 0%
p-value: p=1.000
Staged and simultaneous surgical treatments for CAD with concomitant carotid stenosis are equally safe and effective regarding hospital mortality and complications, though staged procedures require longer hospital stays.
Optimal timing of carotid and coronary revascularization remains uncertain; Level 5 data leaves open whether staged or simultaneous strategies improve safety or efficacy.
Background : Coronary artery disease (CAD) in 16.6% of cases is associated with concomitant carotid arterial involvement, with this proportion reaching up to 40% in the elderly patients. According to the guidelines on myocardial revascularization and surgical treatment of brachycephalic artery (BCA) stenosis, the surgical strategies in this patient cohort remains uncertain, with advantages of various techniques being debated. Aim: To evaluate efficacy and safety of the staged or simultaneous surgery of patients with multifocal atherosclerosis (CAD with BCA atherosclerosis). Materials and methods : Patients were recruited into this single center study retrospectively with "continuous follow-up". From September 2012 to March 2019, 3718 CAD patients underwent coronary artery bypass grafting. Concomitant BCA involvement was found in 574 (15.4%) of the cases (the study group). The mean age of the patients in the study group was 65.9 ± 14.2 years (38 to 84 years). There were 171 (29.8%) patients over 70 years of age and most of the patients were male (412, 71.8%). Bilateral BCA involvement was found in 104 (18.1%) of the cases. The staged surgical intervention (1 st step, carotid endarterectomy and 2 nd step, coronary artery bypass grafting) was performed in 441 (76.8%) of the cases (group I), whereas simultaneous interventions in 133 (23.2%) (group II). Results: There was no difference between the groups I and II in the hospital mortality (0.2% vs. 0%, p = 1.000). No between-group differences were found in the rates of complications, such as early postoperative bleedings (n = 8, 1.8% vs. n = 2, 1.5%; p = 1.000), wound infections (4, 0.9% vs. 2, 1.5%; p = 0.410), acute cerebrovascular accidents (n = 1, 0.2% vs. n = 1,0.8%; p = 0.36), and acute myocardial infarction (n = 1, 0.2% vs. 0; p = 1.000). The longest total duration of in-hospital stay (considering all hospitalizations taken together) was in patients who had undergone staged interventions (p < 0.001). Conclusion: Surgical treatment of CAD with concomitant BCA involvement can be effectively and safely performed both as separate procedures, as well as simultaneously, based on the patient's comorbidities and special aspects of the underlying disorders.
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Schneider et al. (2019) conducted a cohort in Coronary artery disease with concomitant carotid stenosis (n=574). Staged surgical intervention (carotid endarterectomy followed by coronary artery bypass grafting) vs. Simultaneous surgical intervention was evaluated on Hospital mortality (p=1.000). Staged and simultaneous surgical treatments for coronary artery disease with concomitant carotid stenosis resulted in similar hospital mortality rates (0.2% vs 0%, p=1.000).
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