Simultaneous Hybrid Or Staged Carotid Artery Stenting And Off-pump Coronary Artery Bypass For Treatment Of Coronary Artery Disease In Patients With Concomitant Serious Carotid Artery Stenosis

Objectives:To evaluate the efficacy and safety of simultaneous hybrid carotid artery stenting and off-pump coronary artery bypass in the treatment of coronary artery disease associated with serious carotid artery stenosis.Methods:From January2008to December2010,30consecutive patients of CAD associated with serious carotid artery stenosis underwent off-pump coronary artery bypass. Fifteen patients received the hybrid revascularization by carotid artery stenting, immediately followed by off-pump coronary artery bypass and15consecutive patients underwent staged carotid artery stenting and off-pump coronary artery bypass.Results:Revascularization were successful in all30patients (100%). There were no procedure-related complications and no in-hospital death for both procedures. Although the postoperative courses were uneventful with the exception of2patients who suffered from strokes, no vital organ dysfunction occurred. In the staged group, atrial fibrillation, acute renal inefficiency and reoperation for bleeding occurred each in1patient, respectively. There was no significant difference in the ventilation time (31.7±27.8h vs17.9±7.06h, P=0.073), intensive care unit stay (87.7±61.6vs52.3±80.8h, P=0.189), and the volume of chest drainage (945±260ml vs764±334ml, P=0.109) between the hybrid revascularization and staged procedure groups. There was a shorter hospital stay after CAS of patients undergoing hybrid CAS-OPCAB compared with staged CAS-OPCAB (9.7±3.3vs17.1±6.9d, P=0.001).Conclusion:For patients with both carotid artery stenosis and coronary artery disease, simultaneous hybrid or staged revascularization by carotid artery stenting, followed with off-pump coronary artery bypass, are feasible, safe, and less invasive therapeutic strategies. Both procedures do not influence the liver and renal function. Besides, no significant difference exists in the volume of chest drainage, ICU stay, respirator time, and between the staged and hybrid procedures. Compared with staged CAS-OPCAB the patients undergoing hybrid CAS-OPCAB strategy needs a shorter postoperative hospital stay time and decreases the total hospitalization cost at hospital. Further investigation are warranted to study its long-term efficacy.