Department of Interventional Cardiology, St-Antonius Hospital, Nieuwegein, the Netherlands.
JACC Cardiovasc Interv. 2011 Nov;4(11):1190-6. doi: 10.1016/j.jcin.2011.07.012.
The purpose of this study was to evaluate the feasibility and safety of the combined outcome of carotid artery stenting (CAS) and coronary artery bypass graft (CABG) surgery in neurologically symptomatic patients.
The risk of perioperative stroke in patients undergoing CABG who report a prior history of transient ischemic attack or stroke has been associated with a 4-fold increased risk as compared to the risk for neurologically asymptomatic patients. It seems appropriate to offer prophylactic carotid endarterectomy to neurologically symptomatic patients who have significant carotid artery disease and are scheduled for CABG. The CAS-CABG outcome for symptomatic patients remains underreported, notwithstanding randomized data supporting CAS for high-risk patients.
In a prospective, single-center study, the periprocedural and long-term outcomes of 57 consecutive patients who underwent CAS before cardiac surgery were analyzed.
The procedural success rate of CAS was 98%. The combined death, stroke, and myocardial infarction rate was 12.3%. The death and major stroke rate from time of CAS to 30 days after cardiac surgery was 3.5%. The myocardial infarction rate from time of CAS to 30 days after cardiac surgery was 1.5%.
This is the first single-center study reporting the combined outcome of CAS-CABG in symptomatic patients. The periprocedural complication rate and long-term results of the CAS-CABG strategy in this high-risk population support the reliability of this approach. In such a high-risk population, this strategy might offer a valuable alternative to the combined surgical approach; however, a large randomized trial is clearly warranted.
本研究旨在评估颈动脉支架置入术（CAS）联合冠状动脉旁路移植术（CABG）治疗有神经系统症状患者的可行性和安全性。
有短暂性脑缺血发作或脑卒中病史的 CABG 患者围手术期脑卒中风险较无神经系统症状患者增加 4 倍。对于有症状且颈动脉疾病严重、拟行 CABG 的患者，似乎应考虑预防性颈动脉内膜切除术。尽管有支持高危患者行 CAS 的随机数据，但症状性患者的 CAS-CABG 结果仍报道较少。
前瞻性、单中心研究分析了 57 例在心脏手术前行 CAS 的连续患者的围手术期和长期结果。
CAS 的手术成功率为 98%。CAS 联合死亡、卒中和心肌梗死的发生率为 12.3%。从 CAS 到心脏手术后 30 天的死亡和主要卒中风率为 3.5%。从 CAS 到心脏手术后 30 天的心肌梗死率为 1.5%。
这是首例报道症状性患者行 CAS-CABG 联合治疗的单中心研究。该高危人群中 CAS-CABG 策略的围手术期并发症发生率和长期结果支持该方法的可靠性。在这种高危人群中，该策略可能为联合手术方法提供有价值的替代方案；但显然需要进行大型随机试验。
