Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Tzoumas, Andreas; Giannopoulos, Stefanos; Charisis, Nektarios; Texakalidis, Pavlos; Kokkinidis, Damianos G.; Zisis, Sokratis N; Machinis, Theofilos; Koullias, George J.

doi:10.1177/1708538120929506

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…Even within the carotid artery stenting group, whether to do a staged procedure or a synchronous one remains debatable. In another meta-analysis including four observational studies comparing staged and concomitant carotid artery stenting and CABG, Tzoumas et al reported an increased risk of 30-day stroke in the concomitant group as compared to the staged one [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Umar,

Bellamy,

Ahmad

et al. 2023

Cureus

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Stroke is a common complication of cardiac surgery, and carotid artery stenosis is an established risk factor for stroke. Therefore, patients with carotid artery stenosis who are undergoing cardiac surgery require proper management of the former either simultaneously or before cardiac surgery. We present a challenging case of a 67-year-old male patient who presented with generalized weakness, severe aortic stenosis, and significant bilateral carotid artery stenosis. The coexistence of these findings sparked a debate about whether to perform a carotid endarterectomy first or an aortic valve replacement. Moreover, a past history of percutaneous coronary intervention and coronary artery bypass grafts made the decision more challenging. Multiple approaches have been employed for the management of coexisting carotid artery stenosis with cardiac surgery; however, no definitive guidelines exist, especially for surgeries other than coronary artery bypass grafts or where the carotid stenosis is bilateral and severe.

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Section: Discussionmentioning

confidence: 99%

Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Umar,

Bellamy,

Ahmad

et al. 2023

Cureus

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“…Major adverse cardiac and cerebrovascular events (MACCE) within this patient collective are driven by myocardial infarction, stroke or transient ischemic attack (TIA) and an elevated all-cause mortality [4][5][6]. With respect to the optimal approach for patients with concomitant cardiac vitium and internal carotid stenosis, several concepts were analyzed [7,8]. The approach with respect to timing and modality of the carotid revascularization is subject The analysis of intraoperative characteristics for the no-MACCE and MACCE groups is shown in Table 2 with respect to number of carotid endarterectomy using a patch, coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, mitral valve repair, tricuspid valve repair, atrial ablation, atrial exclusion, concomitant surgery, the use of cardio-pulmonal bypass, cardiopulmonary bypass time, aortic cross clamp time, operation time and number of intraoperatively used intra-aortic balloon pump supports.…”

Section: Introductionmentioning

confidence: 99%

Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy

Gerfer,

Bennour,

Chigri

et al. 2023

JCDD

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Background. Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. Methods. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Results. Preoperative patient’s characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Conclusions. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.

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“…4,5 Several approaches and concepts were analysed for this specific cohort of patients. 6,7 The timing and the modality of carotid revascularization were controversially discussed and should be based on clinical presentation, level of emergency, and severity of carotid and coronary artery diseases. Current guidelines on myocardial revascularization recommend for patients scheduled for coronary artery bypass grafting (CABG) with a history of stroke/TIA (<6 months) and 50–99% carotid stenosis that carotid revascularization should be considered (Class IIa, Level B).…”

Section: Introductionmentioning

confidence: 99%

Heart surgery and simultaneous carotid endarterectomy – 10-years single-center experience

et al. 2022

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Background Patients with coronary artery heart disease frequently suffer concomitant carotid vascular disease and are at high perioperative risk for neurological adverse events. Several concepts regarding the timing and modality of carotid revascularization are controversially discussed in patients with heart disease. Current guidelines recommendations on myocardial revascularization recommend a concomitant carotid endarterectomy (CEA) in patients with a history of stroke/transient ischemic attack (TIA) or 50–99% grade of the carotid stenosis. Our study aimed to analyze early outcome parameters of patients undergoing coronary artery bypass grafting (CABG), but also including concomitant heart valve surgery and simultaneous CEA. Methods This study retrospectively analyzed a cohort of 111 patients from our institutional database undergoing heart surgery with CABG or heart-valve surgery between 2010 and 2020 with concomitant carotid surgery due to significant carotid stenosis. Results Patients undergoing heart and simultaneous carotid surgery were 77 ± 8.0 years of age with a body mass index of 28 ± 1.7 kg/m2 and a mean EuroSCORE II of 6.5 ± 2.3. Most patients (61%) had a smoking history and arterial hypertension (97%). The preoperative mean grade of internal carotid stenosis was 87 ± 4.2%, 13% of patients suffered from internal carotid artery stenosis on both sites. In total, 4.5% of patients had previously undergone internal carotid artery intervention before and 6.3% had a history of stroke with a persistent neurologic disorder in 1.8%, 8.9% of cases had prior TIA. Thirty-day all-cause mortality was 6.3% and postoperative neurologic events occurred with 7.2% TIA and 4.5% of disabling stroke. Conclusion Within the reported patient population of coronary artery heart disease and significant internal carotid stenosis, a one-time approach with CABG or heart-valve surgery and CEA is safe and feasible as justified by clinical and neurological postoperative outcomes.

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Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Cited by 13 publications

References 34 publications

Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review

Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy

Heart surgery and simultaneous carotid endarterectomy – 10-years single-center experience

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