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Original Articles: Cardiovascular

Sequential Hybrid Carotid and Coronary Artery Revascularization: Immediate and Mid-Term Results

^a Department of Cardiology, University of Tor Vergata, Rome, Italy
^b Department of Cardiac Surgery, University of Tor Vergata, Rome, Italy
^c Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy

Accepted for publication May 21, 2007.

^_* Address correspondence to Dr Chiariello, Cattedra di Cardiochirurgia, Università di Roma Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, Rome, 00133, Italy. (Email: chiariello{at}tiscali.it).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: To minimize event rates in patients with elevated cardiovascular surgical risk, we investigated a new therapeutic strategy consisting of simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG).

Methods: The study included 37 patients with severe carotid and coronary artery disease and a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5 or higher. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, myocardial infarction, or death at 30 days. Secondary end points were a combination of transient ischemic attack, major local complications, bleeding, and systemic complications within the 30 days after treatment, and any stroke, acute myocardial infarction, or death from day 31 through to the end of the follow-up. All clinical outcomes were assessed by an independent monitoring board.

Results: The rate of procedural success was 97.3%. The 30-day cumulative incidence of disabling stroke, myocardial infarction, or death was 8.1%: 2 patients (5.4%) died, and 1 patient had a stroke immediately after carotid stenting. Another patient died between day 31 and 6 months after the intervention.

Conclusions: Our findings indicate that in elevated-surgical-risk patients with carotid stenosis and coronary artery disease suitable for CABG, hybrid revascularization by CAS, immediately followed by CABG, is a feasible and promising therapeutic strategy.

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				F. Versaci, B. Reimers, C. Del Giudice, J. Schofer, A. Giacomin, S. Sacca, R. Gandini, R. Albiero, A. Pellegrino, F. Bertoldo, et al. Simultaneous Hybrid Revascularization by Carotid Stenting and Coronary Artery Bypass Grafting: The SHARP Study J. Am. Coll. Cardiol. Intv., May 1, 2009; 2(5): 393 - 401. [Abstract] [Full Text] [PDF]