Carotid artery stenting followed by open heart surgery in 323 patients: One-year results and influencing factors

Catheter Cardiovasc Interv. 2018 Feb 15;91(S1):632-638. doi: 10.1002/ccd.27486. Epub 2018 Jan 22.

Abstract

Objectives: The purpose of this study was to evaluate 1-year results and influencing factors of carotid artery stenting (CAS) before open heart surgery (OHS).

Background: Currently, the clinical outcomes and influencing factors of CAS followed by OHS still remain controversial.

Methods: Three hundred twenty-three consecutive patients scheduled for CAS and OHS were enrolled in this study. The primary endpoint was a composite of major stroke, myocardial infarction, or death within 1 year after CAS.

Results: The incidence of the primary endpoint was 5.6% (18/323). The Cox regression analysis revealed that an interval of ≤5 days between CAS and OHS (HR, 4.85, 95% CI, 1.87-12.58; P = 0.001), congestive heart failure (HR, 4.08, 95% CI, 1.45-11.51; P = 0.008), and renal insufficiency (HR, 4.56, 95% CI, 1.28-16.32; P = 0.020) could independently predict the incidence of the primary endpoint. The rate of the primary endpoint from CAS to 30 days after OHS was 4.6% (15/323). An interval of ≤5 days between CAS and OHS (OR, 4.51, 95% CI, 1.52-13.36; P = 0.007) and congestive heart failure (OR, 5.32, 95% CI, 1.63-17.43; P = 0.006) were identified as independent risk factors for the primary endpoint rate from CAS to 30 days after OHS by logistic regression analysis.

Conclusions: CAS followed by OHS is a safe and effective treatment for patients with concomitant carotid and cardiac disease within 1-year follow up. The interval between CAS and OHS, congestive heart failure, and renal insufficiency could obviously influence the 1-year results.

Keywords: cardiac surgical procedures; carotid stenosis; complications; interval; stents.

MeSH terms

  • Aged
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / mortality
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / mortality
  • Carotid Stenosis / surgery*
  • China
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Endovascular Procedures / mortality
  • Female
  • Heart Diseases / complications
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / mortality
  • Heart Diseases / surgery*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Stents*
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome