Wen Mingxiu, Li Jinzhang, Jia Songhao, Wang Shipan, Zhao Shuanglei, Su Pixiong, Xu Dong, Gong Ming
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.
Int J Cardiol Heart Vasc. 2024 Dec 14;56:101497. doi: 10.1016/j.ijcha.2024.101497. eCollection 2025 Feb.
The objective was to evaluate the relationship between carotid stenting and off-pump coronary artery grafting (CAS-OPCABG) and OPCABG only in patients with asymptomatic severe carotid stenosis.
This study retrospectively included 669 patients with asymptomatic severe carotid artery stenosis who underwent OPCABG at multiple centers. After propensity score matching for baseline characteristics, the study compared two groups of patients with clinical data, early and midterm death, stroke, and myocardial infarction (MI).
After matching, there was no significant difference between two groups at baseline. The rates of early stroke, midterm stroke, and intensive care unit (ICU) stay were significantly lower in the CAS OPCABG group, yet the use of the internal mammary artery (IMA) was comparatively lower. Kaplan-Meier analysis revealed that there was no significant difference in midterm mortality between two groups. In the bilateral asymptomatic carotid stenosis subgroup, the early stroke rate was significantly lower after CAS-OPCABG, but there was no significant difference in the unilateral carotid stenosis subgroup. Multivariate logistic regression analysis identified previous atrial fibrillation, previous stroke, aortic atherosclerosis, bilateral carotid stenosis and the use of an intra-aortic balloon pump (IABP) as significant risk factors for early postoperative stroke, CAS emerged as a protective factor. Use of IMA was found to be a protective factor against postoperative mortality.
CAS-OPCABG is an efficacious and safe approach for the treatment of asymptomatic severe carotid artery stenosis, effectively decreasing the incidence of postoperative stroke.
旨在评估无症状重度颈动脉狭窄患者行颈动脉支架置入术与非体外循环冠状动脉旁路移植术（CAS-OPCABG）及单纯OPCABG之间的关系。
本研究回顾性纳入了多家中心行OPCABG的669例无症状重度颈动脉狭窄患者。在对基线特征进行倾向评分匹配后，研究比较了两组患者的临床资料、早期和中期死亡、卒中及心肌梗死（MI）情况。
匹配后，两组在基线时无显著差异。CAS-OPCABG组的早期卒中、中期卒中和重症监护病房（ICU）住院率显著更低，但乳内动脉（IMA）的使用率相对较低。Kaplan-Meier分析显示，两组中期死亡率无显著差异。在双侧无症状颈动脉狭窄亚组中，CAS-OPCABG术后早期卒中率显著更低，但在单侧颈动脉狭窄亚组中无显著差异。多因素逻辑回归分析确定既往房颤、既往卒中、主动脉粥样硬化、双侧颈动脉狭窄及主动脉内球囊泵（IABP）的使用为术后早期卒中的显著危险因素，CAS为保护因素。发现IMA的使用是预防术后死亡的保护因素。
CAS-OPCABG是治疗无症状重度颈动脉狭窄的一种有效且安全的方法，可有效降低术后卒中发生率。
