Velissaris I, Kiskinis D, Anastasiadis K
Department of Cardiovascular Surgery, Kyanous Stavros Hospital, Thessaloniki, Greece.
J Cardiovasc Surg (Torino). 2011 Aug;52(4):539-43.
The optimal management of the patients requiring cardiac surgery with simultaneous severe carotid disease remains controversial. The traditional approach involves staged or combined carotid endarterectomy and cardiac surgery. This study evaluated the feasibility and safety of angioplasty and stenting for the treatment of carotid stenoses combined with cardiac operations in order to reduce the risk of perioperative stroke.
In a prospective, non-randomized study, we analyzed 70 consecutive patients requiring cardiac surgery with simultaneous severe carotid artery disease that underwent carotid artery stenting (CAS) and cardiac surgery in one stage. Symptomatic patients with ≥ 60% carotid stenosis, and asymptomatic patients with ≥ 70% stenosis, were treated using CAS under local anesthesia immediately before the open heart surgery. Cerebral protection devices were used in all cases.
Despite the high baseline risk profile, our results were very encouraging. Carotid stenting was successful in all patients. No neurological complications occurred during the carotid stenting procedures. The 30-day death/stroke rate was 1.4% (no deaths, 1 contralateral minor stroke). No myocardial infarctions occurred. The carotid restenosis rate was zero during the long-term follow up.
The low complication rate suggests that CAS and cardiac surgery in one stage offers a safer therapeutic option compared to combined carotid endarterectomy and cardiac surgery. It may also be safer than with the staged CAS and coronary artery bypass grafting approach as well.
对于需要同时进行心脏手术和严重颈动脉疾病治疗的患者，最佳治疗方案仍存在争议。传统方法包括分期或联合进行颈动脉内膜切除术和心脏手术。本研究评估血管成形术和支架置入术治疗合并心脏手术的颈动脉狭窄的可行性和安全性，以降低围手术期卒中风险。
在一项前瞻性、非随机研究中，我们分析了70例连续的需要同时进行心脏手术和严重颈动脉疾病治疗的患者，他们接受了一期颈动脉支架置入术（CAS）和心脏手术。有症状且颈动脉狭窄≥60%的患者，以及无症状且狭窄≥70%的患者，在心脏直视手术前立即在局部麻醉下接受CAS治疗。所有病例均使用脑保护装置。
尽管基线风险较高，但我们的结果非常令人鼓舞。所有患者的颈动脉支架置入术均成功。在颈动脉支架置入过程中未发生神经并发症。30天死亡/卒中率为1.4%（无死亡，1例对侧轻度卒中）。未发生心肌梗死。长期随访期间颈动脉再狭窄率为零。
低并发症率表明，与联合颈动脉内膜切除术和心脏手术相比，一期CAS和心脏手术提供了一种更安全的治疗选择。它可能也比分期CAS和冠状动脉旁路移植术更安全。
