Key result
IABP and temporary pacing enable successful CAS before CABG by preventing severe hypotension and bradycardia.
Why the study?
Carotid artery stenting can induce hypotension and bradycardia from the carotid node reflex, posing significant danger in patients with severe ischemic heart disease undergoing revascularization.
Case Report (n=1)
No
CAS prior to CABG can be successfully performed using IABP and a temporary pacemaker to manage hemodynamic instability in patients with severe concomitant coronary and carotid artery stenosis.
Supports feasibility of pre-CABG CAS with IABP and temporary pacing in severe stenosis; hypothesis-generating pending controlled trials.
The risk factors of carotid stenosis and coronary stenosis are similar, and therefore, certain patients with carotid stenosis may have coronary heart disease. Coronary artery bypass graft (CABG) is the major therapy for ischemic heart disease with three-vessel and left main coronary artery (LMCA) disease. However, CABG can induce cerebral infarctions in cases with carotid stenosis. Carotid endarterectomy (CEA) was used to be the standard therapy for carotid stenosis; however, CEA requires general anesthesia and has a high risk of cardiovascular events in patients with ischemic heart disease. In recent times, carotid artery stenting (CAS), which does not need general anesthesia, is the new strategy for carotid stenosis. However, CAS induces hypotension and bradycardia because of a carotid node reflex, which is dangerous in patients with ischemic heart disease. We reported a case of the coexistence of severe coronary stenosis including the LMCA and three vessels and carotid stenosis. CAS before CABG under local anesthesia was successful with the use of intra-aortic balloon pumping (IABP) and a temporary pacemaker.
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Sato et al. (2020) conducted a case report in Severe coronary and carotid artery stenosis (n=1). Carotid artery stenting with intra-aortic balloon pumping and temporary pacemaker was evaluated on Prevention of severe heart failure or fatal arrhythmias during CAS. Carotid artery stenting before coronary artery bypass grafting was successfully performed using intra-aortic balloon pumping and a temporary pacemaker to prevent severe hypotension and bradycardia.
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