Clinical prognosis of staged coronary artery bypass grafting and carotid stent implantation in patients with preoperative stroke_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIA Qi , LUO Chentao , LIN Yi , SHI Yunqing , MA Runhua ,  DING Wenjun

Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;

Corresponding?author：

DING Wenjun, Email: ding.wenjun@zs-hospital.sh.cn

Keywords：

Stage; carotid artery stenting; coronary artery bypass grafting; coronary heart disease; carotid artery stenosis

DOI：

10.7507/1007-4848.202110022

Video：

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Objective To analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. Methods We reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). Conclusion Staged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.

Citation： XIA Qi, LUO Chentao, LIN Yi, SHI Yunqing, MA Runhua, DING Wenjun. Clinical prognosis of staged coronary artery bypass grafting and carotid stent implantation in patients with preoperative stroke. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 565-571. doi: 10.7507/1007-4848.202110022 Copy

1.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
2.	Naylor AR, Ricco JB, de Borst GJ, et al. Editor's choice—Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
3.	Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol, 2011, 57(8): 1002-1044.
4.	中國心臟內外科冠心病血運重建專家共識組. 中國心臟內、外科冠心病血運重建專家共識. 中華胸心血管外科雜志, 2016, 32(12): 707-716.
5.	Drakopoulou M, Oikonomou G, Soulaidopoulos S, et al. Management of patients with concomitant coronary and carotid artery disease. Expert Rev Cardiovasc Ther, 2019, 17(8): 575-583.
6.	王增武, 胡盛壽, 《中國心血管健康與疾病報告2019》編寫組. 《中國心血管健康與疾病報告2019》要點解讀. 中國心血管雜志, 2020, 25(5): 401-410.
7.	Tanimoto S, Ikari Y, Tanabe K, et al. Prevalence of carotid artery stenosis in patients with coronary artery disease in Japanese population. Stroke, 2005, 36(10): 2094-2098.
8.	Kawarada O, Yokoi Y, Morioka N, et al. Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting. Circ J, 2003, 67(12): 1003-1006.
9.	Naylor AR, Mehta Z, Rothwell PM, et al. Carotid artery disease and stroke during coronary artery bypass: A critical review of the literature. Eur J Vasc Endovasc Surg, 2002, 23(4): 283-294.
10.	Vincent S, Eberg M, Eisenberg MJ, et al. Meta-analysis of randomized controlled trials comparing the long-term outcomes of carotid artery stenting versus endarterectomy. Circ Cardiovasc Qual Outcomes, 2015, 8(6 Suppl 3): S99-S108.
11.	Shen Y, Jin S, Lin C, et al. Safety of different carotid artery revascularization strategies in the coronary artery bypass graft population: Study protocol for a systematic review and network meta-analysis. Ann Transl Med, 2020, 8(23): 1605.
12.	丁文惠, 秦明照, 林展翼, 等. 老年人頸動脈粥樣硬化性疾病診治中國專家建議. 中華老年醫學雜志, 2013, 2: 113-120.
13.	韓雅玲, 中華醫學會心血管病學分會介入心臟病學組, 中國醫師協會心血管內科醫師分會血栓防治專業委員會, 等. 中國經皮冠狀動脈介入治療指南(2016). 中華心血管病雜志, 2016, 44(5): 382-400.
14.	于逢春, 北京神經內科學會, 北京心臟學會, 等. 頸動脈與冠狀動脈同期血運重建專家共識. 中國腦血管病雜志, 2020, 17(12): 772-783.
15.	Habib N, Mahmoodi BK, Suttorp MJ, et al. Long-term results of carotid stenting and risk factors in patients with severe carotid artery stenosis undergoing subsequent cardiac surgery. Catheter Cardiovasc Interv, 2019, 93(3): E134-E139.
16.	Van der Heyden J, Van Neerven D, Sonker U, et al. Carotid artery stenting and cardiac surgery in symptomatic patients. JACC Cardiovasc Interv, 2011, 4(11): 1190-1196.
17.	Paraskevas KI, Nduwayo S, Saratzis AN, et al. Carotid stenting prior to coronary bypass surgery: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2017, 53(3): 309-319.
18.	Bernhard VM, Johnson WD, Peterson JJ. Carotid artery stenosis. Association with surgery for coronary artery disease. Arch Surg, 1972, 105(6): 837-840.
19.	Chan JSK, Shafi AMA, Grafton-Clarke C, et al. Concomitant severe carotid and coronary artery diseases: A separate management or concomitant approach. J Card Surg, 2019, 34(9): 803-813.
20.	Poi MJ, Echeverria A, Lin PH. Contemporary management of patients with concomitant coronary and carotid artery disease. World J Surg, 2018, 42(1): 272-282.
21.	Tzoumas A, Giannopoulos S, Charisis N, et al. Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis. Vascular, 2020, 28(6): 808-815.
22.	Xiang B, Luo X, Yang Y, et al. Midterm results of coronary artery bypass graft surgery after synchronous or staged carotid revascularization. J Vasc Surg, 2019, 70(6): 1942-1949.
23.	Giannopoulos S, Texakalidis P, Charisis N, et al. Synchronous carotid endarterectomy and coronary artery bypass graft versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid stenosis: A systematic review and meta-analysis. Ann Vasc Surg, 2020, 62: 463-473.
24.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58(24): e123-e210.
25.	Zhang J, Xu RW, Fan X, et al. A systematic review of early results following synchronous or staged carotid artery stenting and coronary artery bypass grafting. Thorac Cardiovasc Surg, 2017, 65(4): 302-310.
26.	Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endovasc Surg, 2009, 37(4): 379-387.
27.	Timaran CH, Rosero EB, Smith ST, et al. Trends and outcomes of concurrent carotid revascularization and coronary bypass. J Vasc Surg, 2008, 48(2): 355-360.

1. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23): 2610-2642.
2. Naylor AR, Ricco JB, de Borst GJ, et al. Editor's choice—Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
3. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol, 2011, 57(8): 1002-1044.
4. 中國心臟內外科冠心病血運重建專家共識組. 中國心臟內、外科冠心病血運重建專家共識. 中華胸心血管外科雜志, 2016, 32(12): 707-716.
5. Drakopoulou M, Oikonomou G, Soulaidopoulos S, et al. Management of patients with concomitant coronary and carotid artery disease. Expert Rev Cardiovasc Ther, 2019, 17(8): 575-583.
6. 王增武, 胡盛壽, 《中國心血管健康與疾病報告2019》編寫組. 《中國心血管健康與疾病報告2019》要點解讀. 中國心血管雜志, 2020, 25(5): 401-410.
7. Tanimoto S, Ikari Y, Tanabe K, et al. Prevalence of carotid artery stenosis in patients with coronary artery disease in Japanese population. Stroke, 2005, 36(10): 2094-2098.
8. Kawarada O, Yokoi Y, Morioka N, et al. Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting. Circ J, 2003, 67(12): 1003-1006.
9. Naylor AR, Mehta Z, Rothwell PM, et al. Carotid artery disease and stroke during coronary artery bypass: A critical review of the literature. Eur J Vasc Endovasc Surg, 2002, 23(4): 283-294.
10. Vincent S, Eberg M, Eisenberg MJ, et al. Meta-analysis of randomized controlled trials comparing the long-term outcomes of carotid artery stenting versus endarterectomy. Circ Cardiovasc Qual Outcomes, 2015, 8(6 Suppl 3): S99-S108.
11. Shen Y, Jin S, Lin C, et al. Safety of different carotid artery revascularization strategies in the coronary artery bypass graft population: Study protocol for a systematic review and network meta-analysis. Ann Transl Med, 2020, 8(23): 1605.
12. 丁文惠, 秦明照, 林展翼, 等. 老年人頸動脈粥樣硬化性疾病診治中國專家建議. 中華老年醫學雜志, 2013, 2: 113-120.
13. 韓雅玲, 中華醫學會心血管病學分會介入心臟病學組, 中國醫師協會心血管內科醫師分會血栓防治專業委員會, 等. 中國經皮冠狀動脈介入治療指南(2016). 中華心血管病雜志, 2016, 44(5): 382-400.
14. 于逢春, 北京神經內科學會, 北京心臟學會, 等. 頸動脈與冠狀動脈同期血運重建專家共識. 中國腦血管病雜志, 2020, 17(12): 772-783.
15. Habib N, Mahmoodi BK, Suttorp MJ, et al. Long-term results of carotid stenting and risk factors in patients with severe carotid artery stenosis undergoing subsequent cardiac surgery. Catheter Cardiovasc Interv, 2019, 93(3): E134-E139.
16. Van der Heyden J, Van Neerven D, Sonker U, et al. Carotid artery stenting and cardiac surgery in symptomatic patients. JACC Cardiovasc Interv, 2011, 4(11): 1190-1196.
17. Paraskevas KI, Nduwayo S, Saratzis AN, et al. Carotid stenting prior to coronary bypass surgery: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2017, 53(3): 309-319.
18. Bernhard VM, Johnson WD, Peterson JJ. Carotid artery stenosis. Association with surgery for coronary artery disease. Arch Surg, 1972, 105(6): 837-840.
19. Chan JSK, Shafi AMA, Grafton-Clarke C, et al. Concomitant severe carotid and coronary artery diseases: A separate management or concomitant approach. J Card Surg, 2019, 34(9): 803-813.
20. Poi MJ, Echeverria A, Lin PH. Contemporary management of patients with concomitant coronary and carotid artery disease. World J Surg, 2018, 42(1): 272-282.
21. Tzoumas A, Giannopoulos S, Charisis N, et al. Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis. Vascular, 2020, 28(6): 808-815.
22. Xiang B, Luo X, Yang Y, et al. Midterm results of coronary artery bypass graft surgery after synchronous or staged carotid revascularization. J Vasc Surg, 2019, 70(6): 1942-1949.
23. Giannopoulos S, Texakalidis P, Charisis N, et al. Synchronous carotid endarterectomy and coronary artery bypass graft versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid stenosis: A systematic review and meta-analysis. Ann Vasc Surg, 2020, 62: 463-473.
24. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2011, 58(24): e123-e210.
25. Zhang J, Xu RW, Fan X, et al. A systematic review of early results following synchronous or staged carotid artery stenting and coronary artery bypass grafting. Thorac Cardiovasc Surg, 2017, 65(4): 302-310.
26. Naylor AR, Mehta Z, Rothwell PM. A systematic review and meta-analysis of 30-day outcomes following staged carotid artery stenting and coronary bypass. Eur J Vasc Endovasc Surg, 2009, 37(4): 379-387.
27. Timaran CH, Rosero EB, Smith ST, et al. Trends and outcomes of concurrent carotid revascularization and coronary bypass. J Vasc Surg, 2008, 48(2): 355-360.

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