Post coronary artery bypass graft surgery
Post coronary artery bypass graft surgery
Post coronary artery bypass graft surgery
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Carotid stenting in candidates for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>surgery</strong>: results of a heart hospital registry<br />
Kassaian SE, Kazemisaleh D, Alidoosti M, Salarifar M, Haji Zeinali AM, Hakki<br />
E, Sahraian AM, Gheini MR and Abbasi SH<br />
Abstract<br />
Background: In patients with severe coexisting <strong>coronary</strong> and carotid <strong>artery</strong> disease, 2<br />
treatment strategies may be used: simultaneous endarterectomy and <strong>coronary</strong> <strong>bypass</strong><br />
<strong>surgery</strong> or carotid stenting with delayed <strong>coronary</strong> <strong>bypass</strong> <strong>surgery</strong> after a few weeks. We<br />
sought to evaluate the safety and efficacy of carotid stenting with delayed <strong>coronary</strong><br />
<strong>bypass</strong> <strong>surgery</strong> after a few weeks in patients of Tehran Heart Center. Based on<br />
observations made in this study and previous lesion typing studies, we aimed to<br />
determine predictors that may be used to select the appropriate treatment plan for such<br />
patients.<br />
Methods: Between December 2003 and October 2004, thirty consecutive patients<br />
underwent carotid stenting. The mean age of the patients was 66.3 ± 8 years. All of the<br />
patients had significant <strong>coronary</strong> <strong>artery</strong> disease. Symptomatic patients with>60% stenosis<br />
and symptomatic patients with> 80% stenosis were included. A complete neurological<br />
history was taken and an examination performed on all patients by an experienced<br />
neourologist. The study protocol required that an independent neourologist not involved<br />
in the interventional procedure evaluate parients using the National Institute of Health<br />
Stroke Scale before the procedure and then 24 hours, 1 month, and 6 months after the<br />
procedure. Carotid duplex (based on the Washington criteria), magnetic resonance<br />
imaging, or computed tomographyof the head and complete diagnostic angiography,<br />
including intracranial views and assessment of the collateral circulation, were performed<br />
on all patients. Stenoses were crossed with a 0.014inch filter wire, which was placed at<br />
the site of internal carotid <strong>artery</strong> distal to the lesion. In most cases, predilation (low<br />
profile 3.5-4mm <strong>coronary</strong> balloon and low pressure) was performed before stent<br />
placement. Ballon inflations were routinely performed within the stents after placement.<br />
Continuous intravenous heparin was given during the night, and vascular sheats were<br />
removed the morning after the procedure. The clinical endpoints were major or minor<br />
stroke myocardial infarction, or death during follow up period.<br />
Results: The procedural success rate was 96.66%. For a mean follow up period of 5.6 ±<br />
3.2 months, 4 deaths occurred (17% of cases), none of which were attributed to a<br />
neurologic cause. Also 1(3%) case had a minor non fatal stroke (transient cognitive<br />
disorder). we designed a new evaluation system: anyone of the characteristics in class C<br />
is considered a predictor for events. Increased number of these predictors is associated<br />
with the risk of complications after the procedure. Also between these predictors; stenosis<br />
95%-99% and large crater ulceration of carotid lesions are more important than the<br />
others.<br />
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