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(Circulation. 2007;116:2036-2042.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Staged Carotid Angioplasty and Stenting Followed by Cardiac Surgery in Patients With Severe Asymptomatic Carotid Artery Stenosis

Early and Long-Term Results

Jan Van der Heyden, MD; Maarten J. Suttorp, MD, PhD; Egbert T. Bal, MD; Jef M. Ernst, MD, PhD; Rob G. Ackerstaff, MD, PhD; Jeroen Schaap, MD; Johannes C. Kelder, MD; Mark Schepens, MD, PhD; Herbert W. Plokker, MD, PhD

From the Department of Interventional Cardiology (J.V.d.H., M.J.S., E.T.B., J.M.E., J.S., J.C.K., H.W.P.), Department of Cardiothoracic and Cardiovascular Surgery (M.S.), and Department of Clinical Neurophysiology (R.G.A.), St. Antonius Hospital, Nieuwegein, the Netherlands.

Correspondence to Jan Van der Heyden, MD, Koekoekslaan 1, 3430 EM, Nieuwegein, the Netherlands. E-mail jvdheijden{at}antonius.net

Received August 15, 2006; accepted August 14, 2007.

Background— The strategy for treating patients with severe asymptomatic carotid artery stenosis and cardiac disease remains unresolved. Staged or combined carotid endarterectomy in these patients offers the potential benefit of decreased neurological morbidity during and after cardiac surgery; however, in high-risk patients with severe coronary artery disease, chronic obstructive pulmonary disease, or renal impairment, the incidence of death and stroke is significantly higher.

Methods and Results— We report the results of a prospective, single-center study designed to evaluate the feasibility and safety of carotid artery angioplasty and stenting (CAS) before cardiac surgery in neurologically asymptomatic patients. The periprocedural and long-term outcomes of 356 consecutive patients who underwent CAS before cardiac surgery were analyzed. The procedural success rate of CAS was 97.7%. The death and stroke rate from time of CAS to 30 days after cardiac surgery was 4.8% (n=17). The myocardial infarction rate from time of CAS to 30 days after cardiac surgery was 2.0% (n=7), and the combined death, stroke, and myocardial infarction rate was 6.7% (n=24). Distal embolic protection devices were used in 40% of the cases.

Conclusions— This large cohort of asymptomatic patients who underwent staged CAS and cardiac surgery experienced a low periprocedural complication rate. The high rate of freedom from death and stroke during the 5 years of follow-up supports the long-term durability of this approach. Our findings suggest that this new strategy may become a valuable alternative in the treatment of patients with combined carotid and cardiac disease.

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