Abstract 3832: Sequential Hybrid Carotid and Coronary Artery Revascularization. SHARP Trial: Immediate and Midterm Results
Introduction: The incidence of hard adverse events following combined coronary artery bypass grafting (CABG) - carotid endarterectomy (CEA) procedures is significantly higher than single interventions.
Hypothesis: The aim of the present study is to assess the technical feasibility and safety of a sequential hybrid carotid and coronary revascularization with carotid artery stent implantation (CAS) and CABG in high risk patients.
Methods: Between February 2004 and May 2006, 60 (7.5%) out of 800 patients referred to our Department for CABG had significant concomitant coronary and carotid artery disease. Of these 37 patients (30 males), aged 54–88 (mean age 70,3±8.5) years, with high risk for combined or staged CEA-CABG or CAS -CABG operation were treated with a hybrid revascularization by CAS immediately followed by CABG (Table I⇓). All patients underwent CAS with distal filter protection. Aspirin 100 mg a day had to be started two days before the procedure. At the end of CAS, all patients were transferred to the operating room, were the planned CABG interventions were performed with normothermic cardiopulmonary bypass. Clopidogrel (300 mg as a loading dose, followed by 75 mg a day for a month) was started in the Intensive care unit, 6 hours after the end of CABG, provided that surgical bleeding from the thoracic drainages had definitely stopped. All patients were followed-up every 6 months clinically and by ultrasonography (mean follow-up 10,3±5,3 months, range 1–22).
Results All patients underwent successfully CAS. One patient had stroke and one patient a transient ischemic attack immediately after the CAS (5,4%). There were 2 (5,4%) in hospital deaths by cardiac failure. Event-free survival at the follow-up was 94,6%.
Conclusions In patients with combined carotid and coronary disease at high surgical risk the proposed hybrid approach seems to be an alternative therapeutic strategy.