Email this article Surgical treatment for coronary artery disease with concomitant carotid stenosis: one-center experience
- Authors: Schneider Y.A.1, Tsoi V.G.1, Fomenko M.S.1, Pavlov A.A.1, Shilenko P.A.1
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Affiliations:
- Federal Centers of High Medical Technologies (Kaliningrad)
- Issue: Vol 47, No 4 (2019)
- Pages: 318-325
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1109
- DOI: https://doi.org/10.18786/2072-0505-2019-47-046
- ID: 1109
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Abstract
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 (1st step, carotid endarterectomy and 2nd 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.
About the authors
Yu. A. Schneider
Federal Centers of High Medical Technologies (Kaliningrad)
Email: fake@neicon.ru
ORCID iD: 0000-0002-5572-3076
Yuri A. Schneider - MD, PhD, Professor, Chief Physician.
4 Kaliningradskoe shosse, poselok Rodniki, Guryevsky rayon, Kaliningradskaya oblast', 238312
Russian FederationV. G. Tsoi
Federal Centers of High Medical Technologies (Kaliningrad)
Email: fake@neicon.ru
Victor G. Tsoi - MD, Deputy Chief Physician of Surgery, Head of the Department of Cardiac Surgery No. 11.
4 Kaliningradskoe shosse, poselok Rodniki, Guryevsky rayon, Kaliningradskaya oblast', 238312
Russian FederationM. S. Fomenko
Federal Centers of High Medical Technologies (Kaliningrad)
Author for correspondence.
Email: fomenko.ms@kldcardio.ru
ORCID iD: 0000-0002-5272-8381
Mikhail S. Fomenko - MD, PhD, Cardiovascular Surgeon, Department of Cardiac Surgery No. I1.
4 Kaliningradskoe shosse, poselok Rodniki, Guryevsky rayon, Kaliningradskaya oblast, 238312, Tel.: +7 (4012) 592 000 Russian FederationA. A. Pavlov
Federal Centers of High Medical Technologies (Kaliningrad)
Email: fake@neicon.ru
ORCID iD: 0000-0001-6088-5486
Aleksandr A. Pavlov - MD, Cardiovascular Surgeon, Department of Cardiac Surgery No. 11.
4 Kaliningradskoe shosse, poselok Rodniki, Guryevsky rayon, Kaliningradskaya oblast', 238312
Russian FederationP. A. Shilenko
Federal Centers of High Medical Technologies (Kaliningrad)
Email: fake@neicon.ru
ORCID iD: 0000-0003-4357-9203
Pavel A. Shilenko - MD, Cardiovascular Surgeon, Department of Cardiac Surgery No. 11.
4 Kaliningradskoe shosse, poselok Rodniki, Guryevsky rayon, Kaliningradskaya oblast', 238312
Russian FederationReferences
- Saedi S, Ghadrdoost B, Pouraliakbar H, Zahed-mehr A, Jebelli A. The association between increased carotid intima-media thickness and SYNTAX Score in coronary artery disease: A single center study. Indian Heart J. 2018;70(5): 627-9. doi: 10.1016/j.ihj.2018.01.010.
- Pinto Sousa P, Teixeira G, Gonsalves J, Veiga C, Sa Pinto P, Brandao P, Canedo A, Vouga L, Almeida R. Carotid stenosis in cardiac surgery patients. Rev Port Cir Cardiotorac Vasc. 2017;24(3-4):126.
- Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiolo-gy/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-El-evation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation. 2016;134(10):e123-55. doi: 10.1161/CIR.0000000000000404.
- Naylor AR, Ricco JB. Response to "Re: Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)". Eur J Vasc Endo-vasc Surg. 2018;55(6):902. doi: 10.1016/j.ejvs.2018.03.023.
- Aronow HD, Collins TJ, Gray WA, Jaff MR, Kluck BW, Patel RA, Rosenfield KA, Safian RD, Sobieszczyk PS, Wayangankar SA, White CJ. SCAI/SVM expert consensus statement on carotid stenting: Training and credentialing for carotid stenting. Catheter Cardiovasc Interv. 2016;87(2):188-99. doi: 10.1002/ccd.26304.
- Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, Mclff EB, Moore WS, Panagos PD, Riles TS, Rosenwas-ser RH, Taylor AJ, Jacobs AK, Smith SC Jr, Anderson JL, Adams CD, Albert N, Buller CE, Cre-ager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Hunt SA, Krumholz HM, Kush-ner FG, Lytle BW, Nishimura RA, Ohman EM, Page RL, Riegel B, Stevenson WG, Tarking-ton LG, Yancy CW. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/ SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv. 2013;81(1 ):E76-123. doi: 10.1002/ccd.22983.
- Белов ЮВ, Баяндин НЛ, Косенков АН, Султанян ТД. Одномоментные операции больных с сочетанным поражением коронарных и брахиоцефальных артерий. Ангиология и сосудистая хирургия. 1995;(3): 35-45.
- Giannopoulos S, Texakalidis P, Charisis N, Jonnalagadda AK, Chaitidis N, Giannopou-los S, Kaskoutis C, Machinis T, Koullias GJ. Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft (CABG) versus staged Carotid Artery Stenting and CABG for Patients with Concomitant Severe Coronary and Carotid Stenosis: a Systematic Review and Meta-analysis. Ann Vasc Surg. 2019. pii: S0890-5096(19)30593-X. doi: 10.1016/j.avsg.2019.06.018.
- Likosky DS, Marrin CA, Caplan LR, Baribeau YR, Morton JR, Weintraub RM, Hartman GS, Hernandez F Jr, Braff SP, Charlesworth DC, Malen-ka DJ, Ross CS, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke. 2003;34(12):2830-4. doi: 10.1161/01.STR.0000098650.12386.B3.
- Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endo-vasc Surg. 2009;37(4):379-87. doi: 10.1016/j.ejvs.2008.12.011.
- Donmez AA, Adademir T, Sacli H, Koksal C, Alp M. Comparison of early outcomes with three approaches for combined coronary revascularization and carotid endarterectomy. Braz J Cardiovasc Surg. 2016;31(5):365-70. doi: 10.5935/1678-9741.20160076.
- Ali IM, Cummings B, Sullivan J, Francis S. The risk of cerebrovascular accident in patients with asymptomatic critical carotid artery stenosis who undergo open-heart surgery. Can J Surg. 1998;41(5):374-8.
- Schwartz LB, Bridgman AH, Kieffer RW, Wilcox RA, McCann RL, Tawil MP, Scott SM. Asymptomatic carotid artery stenosis and stroke in patients undergoing cardiopulmonary bypass. J Vasc Surg. 1995;21(1):146-53. doi: 10.1016/s0741-5214(95)70253-9.
- Salasidis GC, Latter DA, Steinmetz OK, Blair JF, Graham AM. Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke. J Vasc Surg. 1995;21(1):154-60. doi: 10.1016/s0741-5214(95)70254-7.
- Prasad SM, Li S, Rankin JS, O'Brien SM, Gam-mie JS, Puskas JD, Shahian DM, Chedrawy EG, Massad MG. Current outcomes of simultaneous carotid endarterectomy and coronary artery bypass graft surgery in North America. World J Surg. 2010;34(10):2292-8. doi: 10.1007/s00268-010-0506-4.
- Национальные рекомендации по ведению пациентов с заболеваниями брахиоцефальных артерий. М.; 2013. 72 с. [Интернет]. Доступно на: http://www.angiolsurgery.org/recommendations/2013/recommendations_brachiocephalic.pdf.
- Ravindra VM, Mazur MD, Kumpati GS, Park MS, Patel AN, Tandar A, Welt FG, Bull D, Couldwell WT, Taussky P. Carotid artery stenosis in the setting of transcatheter aortic valve replacement: Clinical and technical considerations of carotid stenting. World Neurosurg. 2016;86:194-8. doi: 10.1016/j.wneu.2015.09.063.
- Birchley D, Villaquiran J, Akowuah E, Lewis T, Ashley S. Staged carotid endarterectomy under local anaesthetic in patients requiring cardiac surgery. Ann R Coll Surg Engl. 2010;92(5): 373-8. doi: 10.1308/003588410X12628812459850.
- Poi MJ, Echeverria A, Lin PH. Contemporary management of patients with concomitant coronary and carotid artery disease. World J Surg. 2018;42(1):272-82. doi: 10.1007/s00268-017-4103-7.
- Kim JH, Heo SH, Nam HJ, Youn HC, Kim EJ, Lee JS, Kim YS, Kim HY, Koh SH, Chang DI. Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy. J Clin Neurol. 2015;11(4):364-71. doi: 10.3988/jcn.2015.11.4.364.
- Скопин ИИ, Самородская ИВ, Мурысова ДВ, Асатрян ТВ, Урманбетов КС, Валиева РР. Выбор тактики хирургического лечения пациентов старшей возрастной группы с пороками клапанов сердца в сочетании с поражением коронарных и брахиоцефальных артерий. Ангиология и сосудистая хирургия. 2013;19(1):87-91.
- Chan JSK, Shafi AMA, Grafton-Clarke C, Singh S, Harky A. Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach. J Card Surg. 2019. doi: 10.1111/jocs.14145.
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