Early and Long-Term Outcomes After Combined Percutaneous Revascularization in Patients With Carotid and Coronary Artery Stenoses

Study Questions:

What is the outcome of patients who undergo combined percutaneous coronary and carotid intervention?

Methods:

The authors reported the outcome of 239 consecutive patients with carotid artery disease (symptomatic in 20%) and concomitant coronary artery disease, who were treated with staged or simultaneous carotid artery stenting and percutaneous coronary intervention over a 4-year period. The primary endpoint was the composite of any death, myocardial infarction, or stroke occurring between the first revascularization procedure, and 30 days following treatment of the second vascular territory affected.

Results:

The incidence of the primary endpoint at 30 days was 4.2% (95% confidence interval [CI], 2.02-7.56). There was one death (0.4%), three nonfatal MIs (1.3%), and six strokes (2.5%). Transient ischemic attack occurred in six (2.5%), major bleedings in three (1.3%), and acute kidney injury occurred in one patient (0.4%). Over a median follow-up of 520 days, the rate of death (4.2%), myocardial infarction (2.1%), and stroke (3.8%) was low. Patients with previous cardiovascular disease had significantly higher rates of major cardiac and cerebrovascular events compared with patients with a first clinical episode (17% vs. 6%, hazard ratio, 3.34; 95% CI, 1.46-7.63; p = 0.004).

Conclusions:

The authors concluded that patients undergoing staged coronary and carotid revascularization have a favorable clinical outcome.

Perspective:

This study demonstrates the long-term outcome of patients undergoing sequential or simultaneous coronary and carotid artery stenting. Observational data support carotid stenting over carotid endarterectomy in patients undergoing cardiac surgery (J Vasc Surg 2008;48:355-60), and this study extends the results to patients who can undergo percutaneous revascularization for both carotid and coronary beds. The results of this study cannot be directly compared to surgical series, but overall, the results compare favorably with historic controls. These data provide further support for carotid stenting in patients with concomitant extensive coronary artery disease.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine

Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Coronary Stenosis, Endarterectomy, Carotid, Carotid Artery Diseases, Cardiac Surgical Procedures, Percutaneous Coronary Intervention


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