This article is more than 5 years old. Information may no longer be current.
Longer interval between CAS, open heart surgery lowers periprocedural complication risk
Click Here to Manage Email Alerts
Patients with carotid stenosis experienced fewer perioperative complications with an interval between carotid artery stenting and open heart surgery of more than 5 days, according to results from a prospective study.
The researchers evaluated data from 154 patients with carotid artery stenosis scheduled to undergo carotid artery stenting (CAS) and open heart surgery at a single facility between 2005 and June 2010. The cohort was 83.7% men and 16.3% women, with a mean age of 65.7 years. The primary endpoint was incidence of a composite of major stroke or neurological death during 30 days of postoperative follow-up. Secondary endpoints included a composite of major stroke, MI and death, as well as minor stroke and acute kidney injury.
Procedural success for stenting occurred in 99.4% of patients, and 183 stents were implanted in 178 lesions. Patients had a mean interval of 23.2 days between stenting and surgery, with 23.5% undergoing surgery within 5 days of stenting, 60.1% between 5 and 30 days, and 16.3% who underwent surgery more than 30 days after stenting.
Nine adverse events occurred between stenting and surgery: one ipsilateral major stroke, two minor strokes, two MIs, one MI-related death and four patients who developed acute kidney injury. During postoperative follow-up, three patients died, with one death due to neurological causes, one due to cardiac causes and one related to sepsis and acute renal failure. Nonfatal major stroke occurred in three patients, minor stroke in two patients and acute kidney injury in three patients within 30 days of surgery.
The primary endpoint occurred in 3.2% of patients, whereas 5.8% experienced the composite secondary endpoint, 2.6% exhibited minor stroke and 4.5% experienced acute kidney injury. An interval of 5 days or fewer between stenting and surgery was independently predictive of the primary endpoint (OR = 14.06; 95% CI, 1.52-130.13), according to results from multivariate analysis. A shorter interval between the procedures also was independently associated with increased risk for the secondary composite endpoint (OR = 7.05; 95% CI, 1.58-31.4), as was congestive HF (OR = 7.07; 95% CI, 1.55-21.27).
“The present study showed that CAS followed by [open heart surgery] may represent a safe and effective treatment for patients with concomitant carotid and cardiac disease, given the low periprocedural complication rates,” the researchers wrote. “Our findings suggest that an interval between CAS and [open heart surgery] of > 5 days, if the patient’s condition permits, could decrease periprocedural complications, especially major stroke and neurological death.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts