Is there any benefit from staged carotid and coronary revascularization using carotid stents? A single-center experience highlights the need for a randomized controlled trial.
Is there any benefit from staged carotid and coronary revascularization using carotid stents? A single-center experience highlights the need for a randomized controlled trial.
复制标题
使用颈动脉支架进行分期颈动脉和冠状动脉血运重建有什么好处吗？
作者：
M. Randall;F. McKevitt;T. Cleveland;P. Gaines;G. Venables
背景和目的
评估冠状动脉搭桥术前颈动脉支架植入术降低心脏手术期间发生卒中风险的益处。
方法
在冠状动脉旁路手术前接受颈动脉支架植入术或联合旁路和瓣膜置换术的患者中进行了一项前瞻性队列研究，以评估手术预防卒中的有效性。结果指标包括支架植入术后30天和心脏手术神经系统并发症和全因死亡率。
结果
共纳入52例患者。2例患者在冠状动脉血运重建的同时接受了主动脉瓣置换术。支架植入术未发生神经系统并发症。在支架手术的30天随访期内，发生了1例与冠状动脉搭桥手术无关的心源性死亡。在心脏手术后的30天随访期内发生了另外6起（11.5%）结局事件（3起卒中和3起死亡）。3名患者在等待心脏搭桥手术时死于心脏原因。
结论
我们的结果与心脏手术前接受分期或联合颈动脉内膜切除术的患者的结果相当。我们的小型队列研究增加了关于该主题的有限的世界文献，但没有足够的动力在实践中推荐改变。
BACKGROUND AND PURPOSE
To assess the benefits of carotid artery stenting before coronary artery bypass surgery to reduce the risk of stroke occurring during the cardiac procedure.
METHODS
A prospective cohort study was performed in patients undergoing carotid artery stenting before coronary artery bypass surgery, or combined bypass and valve replacement procedures, to assess the procedures effectiveness in stroke prevention. Outcome measures including 30-day post stenting and cardiac surgery neurological complication and all-cause mortality rates were assessed.
RESULTS
A total of 52 patients were included. Two patients underwent aortic valve replacements at the same time as coronary revascularization. No neurological complications occurred because of the stenting procedure. One cardiac death not related to coronary artery bypass surgery occurred in the 30-day follow-up period for the stent procedure. An additional 6 (11.5%) outcome events (3 strokes and 3 deaths) occurred in the 30-day follow-up period after the cardiac procedure. Three patients died of cardiac causes while awaiting their cardiac bypass procedure.
CONCLUSIONS
Our results are comparable to those in patients that undergo staged or combined carotid endarterectomy before cardiac surgery. Our small cohort study adds to the limited world literature on the subject but is not sufficiently powered to recommend alterations in practice.