Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

Abstract

IntroductionSystemic atherosclerosis can result in both coronary artery disease (CAD) and carotid artery disease. Recently it has been shown that patients with CAD have a higher incidence of microembolization during carotid artery stenting (CAS), and it has been hypothesized that they could be at higher risk in this intervention.Material and methodsWe retrospectively evaluated an institutional registry with 437 consecutive patients who underwent coronary angiography and CAS to evaluate their short-term outcomes and long-term survival with regard to the presence of coexisting multivessel coronary artery disease (MVD).ResultsWe performed 220 CAS procedures in MVD patients and 318 CAS procedures in non-MVD patients. The incidence of in-hospital CAS-related adverse events was 2.7% and 2.5% in the MVD and non-MVD groups, respectively (p = 0.88). At 30 days, there was no significant difference between the groups in terms of the number of patients with adverse events (hierarchically death/stroke/myocardial infarction; 8.8% vs. 5.5%; p = 0.18). The median duration of follow-up was 4.23 years. Survival free of all-cause mortality at 1, 3 and 5 years was 90% (95% CI: 86–94%), 79% (95% CI: 73–85%) and 70% (95% CI: 64–77%), and 92% (95% CI: 89–95%), 85% (95% CI: 80–90%) and 76% (95% CI: 70–82%) for the MVD and non-MVD groups (p = 0.02), respectively.ConclusionsThese results suggest that patients with MVD combined with carotid artery disease are probably not at higher risk of early post-CAS adverse clinical events, but they have significantly worse long-term survival rates.

Survival and Prognostic Factors After Carotid Artery Stenting in Patients with Concomitant Coronary Disease

“…CAS is established as an effective procedure with strict indications and generally accepted intervention protocols [17], [18]. All studies, both earlier and present lead to one conclusion: It is not the neurological complications but rather CHD and cardiovascular pathology that influence early and late complications and lead to reduction in survival following CAS and CEA [19], [20], [21].…”

“…It is no coincidence that CS >50% show increased risk for CHD and are considered equivalent to the above [34], [35]. In patients with symptomatic or asymptomatic carotid stenosis, the presence of CHD increases the risk of vascular cardiocerebral complications during long-term follow-up [21], [36], [37].…”

Comparison of 30-Day Outcomes after Carotid Artery Stenting in Patients with Near-Occlusion and Severe Stenosis: A Propensity Score Matching Analysis

“…Some of the patients were included in previous studies. [12][13][14][15][16] Patient Assessment, Procedure, and Follow-up Patients were referred to carotid angiography and CAS by a neurologist, cardiologist, or vascular surgeon on the basis of Doppler sonography and/or CTA. Patient characteristics are listed in Table 1, and their medication before CAS is found in the Online Supplemental Data.…”