Early-Staged Carotid Artery Stenting Prior to Coronary Artery Bypass Grafting: Analysis of the Early and Mid-Term Results in Comparison with a Consecutive Cohort of Isolated Coronary Artery Surgery Patients

Paolo Nardi; Claudia Altieri; Calogera Pisano; Fabio Massimo Oddi; Alessandro Ranucci; Mauro Fresilli; Alessandro Cristian Salvati; Dario Buioni; Mattia Scognamiglio; Valentina Ajello; Carlo Bassano; Andrea Ascoli Marchetti; Arnaldo Ippoliti; Giovanni Ruvolo

doi:10.3390/jcm13020480

Early-Staged Carotid Artery Stenting Prior to Coronary Artery Bypass Grafting: Analysis of the Early and Mid-Term Results in Comparison with a Consecutive Cohort of Isolated Coronary Artery Surgery Patients

J Clin Med. 2024 Jan 15;13(2):480. doi: 10.3390/jcm13020480.

Affiliations

¹ Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy.
² Unit of Cardiology of the Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy.
³ Unit of Vascular Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
⁴ Unit of Cardio-Thoracic Anesthesia, Tor Vergata University Hospital, 00133 Rome, Italy.

Abstract

Aim: The aim of the present study was to analyze retrospectively the results of patients who underwent early-staged, i.e., within 24-48 h, carotid artery stenting (e-s CAS) before coronary artery bypass grafting (CABG).

Methods: Between December 2014 and December 2022, 1046 consecutive patients underwent CABG; 31 of these patients (3%) were subjected to e-s CAS prior to CABG (e-s CAS + CABG group). Preoperative and intraoperative variables and early and mid-term results of the e-s CAS + CABG group were compared with those of patients who underwent isolated CABG (CABG group).

Results: As compared with the CABG group, the e-s CAS + CABG group showed a worse clinical risk profile due to higher Euroscore-2 values and incidence of obstructive pulmonary disease and bilateral carotid artery and peripheral artery diseases (p < 0.05, for all comparisons). The combined end point of operative mortality, periprocedural myocardial infarction, and stroke was 3.2% (0%/0%/3.2%) in the e-s CAS + CABG group vs. 5.9% (2.2%/2.8%/0.9%) in the CABG group (p > 0.5, for all measurements). At 5 years, actuarial survival was 74% ± 16% in the e-s CAS + CABG group vs. 93% ± 4.0% in the CABG group, freedom from cardiac death was 100% vs. 98% ± 1.0% (p = 0.6), and freedom from MACCEs was 85% ± 15% vs. 97% ± 2.5% (p > 0.1, for all comparisons). Independent predictors of all-causes death were advanced age at the operation (p < 0.0001), a lower value for left ventricular ejection fraction (p = 0.05), and a high Euroscore-2 (p = 0.04).

Conclusions: CABG preceded by e-s CAS appears to be associated with satisfactory early outcomes while limiting the risk of myocardial infarction to a very short time interval between the two procedures. Freedom from late all-causes death, cardiac death, and MACCEs were comparable and equally satisfactory, underscoring the positive protective effects of CAS and CABG on the carotid and coronary territories over time.

Keywords: carotid artery stenting; carotid endarterectomy; coronary artery bypass grafting; myocardial infarction.

Grants and funding

This research received no external funding.