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Hybrid strategy shows promise vs. concomitant carotid, cardiac surgery
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Results of a small study indicated that a hybrid strategy of carotid artery stenting and coronary bypass surgery was associated with a similar 30-day rate of stroke and death compared with concomitant carotid and cardiac surgery.
The researchers noted that there are increased risks for morbidity and mortality associated with concomitant carotid and cardiac surgery, but that it is unknown whether the hybrid of carotid artery stenting and coronary bypass surgery decreases stroke risk or other complications.
They aimed to compare early outcomes for hybrid stenting and coronary bypass grafting with those reported for open concomitant carotid and coronary bypass surgery in a cohort of 20 patients.
There were 10 patients in the hybrid stenting and coronary bypass surgery group and 10 in the concomitant carotid and coronary surgery group.
Clinicians compared preoperative, intraoperative and postoperative variables for the patient population.
Combined incidence of stroke and death at 30 days after the procedure or during initial hospitalization served as the primary outcome measure, whereas MI, atrial fibrillation, blood loss and need for transfusion, and duration of stay in the hospital or ICU served as the secondary outcome measures.
Patients in the hybrid stenting and bypass group were aged 65.3 ± 6.8 years compared with 70.7 ± 7 years for the concomitant surgery group (P=.191). The groups were also comparable in terms of NYHA class (hybrid, 2.3 ± 0.5 vs. concomitant, 1.8 ± 0.7; P=.218), EuroSCORE (hybrid, 2.8 ± 2.0 vs. concomitant, 3.6 ± 2.3; P=.547), the degree of carotid stenosis (hybrid, 79 ± 12% vs. concomitant, 87 ± 13%; P=.224) and average left ventricular ejection fraction (hybrid, 44.3 ± 12.4% vs. concomitant, 43.4 ± 13.3%; P=.896).
Intraoperative variables were also similar between the two groups. However, the hybrid stenting and bypass group had shorter extracorporeal circulation time (65.7 ± 14.1 min vs. 90 +17.4 min; P=.023).
Primary endpoint analysis results indicated that there was one stroke and one death in the concomitant surgery group (20%); these were the only primary endpoint events, and the researchers noted that there was no significant difference between the groups in terms of this endpoint. Mechanical ventilation, need for transfusion and duration of ICU and hospital stay also were not significantly different between the two groups.
“Although limited by a small sample size, our results show that the hybrid procedure of carotid stenting and coronary surgery might be a good therapeutic option but further extended studies are needed to assess its real value,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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