One-stop carotid endarterectomy and off-pump coronary artery bypass grafting for patients with coronary artery disease and carotid artery stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Jianbing ¹ , JIANG Zhaolei ¹ , MEI Ju ¹ , TANG Min ¹ , LIU Hao ¹ , SHEN Sai'e ² ,  DING Fangbao ¹

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

DING Fangbao, Email: dingfangbao@xinhuamed.com.cn

Keywords：

Carotid artery stenosis; coronary artery disease; carotid endarterectomy; off-pump coronary artery bypass grafting; one-stop

DOI：

10.7507/1007-4848.202204032

Video：

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Objective To analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. Methods The clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. Results A total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. Conclusion One-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.

Citation： HUANG Jianbing, JIANG Zhaolei, MEI Ju, TANG Min, LIU Hao, SHEN Sai'e, DING Fangbao. One-stop carotid endarterectomy and off-pump coronary artery bypass grafting for patients with coronary artery disease and carotid artery stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1720-1724. doi: 10.7507/1007-4848.202204032 Copy

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2.	Brunner G, Virani SS, Sun W, et al. Associations between carotid artery plaque burden, plaque characteristics, and cardiovascular events: The ARIC carotid magnetic resonance imaging study. JAMA Cardiol, 2021, 6(1): 79-86.
3.	Selwaness M, Bos D, van den Bouwhuijsen Q, et al. Carotid atherosclerotic plaque characteristics on magnetic resonance imaging relate with history of stroke and coronary heart disease. Stroke, 2016, 47(6): 1542-1547.
4.	Schermerhorn ML, Liang P, Eldrup-Jorgensen J, et al. Association of transcarotid artery revascularization vs. transfemoral carotid artery stenting with stroke or death among patients with carotid artery stenosis. JAMA, 2019, 322(23): 2313-2322.
5.	Beckman JA. Management of asymptomatic internal carotid artery stenosis. JAMA, 2013, 310(15): 1612-1618.
6.	Bos D, Arshi B, van den Bouwhuijsen QJA, et al. Atherosclerotic carotid plaque composition and incident stroke and coronary events. J Am Coll Cardiol, 2021, 77(11): 1426-1435.
7.	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.
8.	Roffi M, Ribichini F, Castriota F, et al. Management of combined severe carotid and coronary artery disease. Curr Cardiol Rep, 2012, 14(2): 125-134.
9.	Manthey S, Spears J, Goldberg S. Coexisting coronary and carotid artery disease: Which technique and in which order? Case report and review of literature. Clin Med Insights Cardiol, 2020, 14: 1179546820951797.
10.	夏琦, 骆晨涛, 林熠, 等. 分期行冠状动脉旁路移植术和颈动脉支架植入术对术前脑卒中患者的临床预后研究. 中国胸心血管外科临床杂志, 2022, 29(5): 565-571.
11.	Abbott AL, Paraskevas KI, Kakkos SK, et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke, 2015, 46(11): 3288-3301.
12.	Marsman MS, Wetterslev J, Jahrome AK, et al. Carotid endarterectomy with patch angioplasty versus primary closure in patients with symptomatic and significant stenosis: A systematic review with meta-analyses and trial sequential analysis of randomized clinical trials. Syst Rev, 2021, 10(1): 139.
13.	Cheng SF, Richards T, Gregson J, et al. Long term restenosis rate after carotid endarterectomy: Comparison of three surgical techniques and intra-operative shunt use. Eur J Vasc Endovasc Surg, 2021, 62(4): 513-521.
14.	Santarpino G, Nicolini F, De Feo M, et al. Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting. Eur J Vasc Endovasc Surg, 2018, 56(5): 741-748.
15.	Ogutu P, Werner R, Oertel F, et al. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery? Interact Cardiovasc Thorac Surg, 2014, 18(4): 511-518.
16.	Feldman DN, Swaminathan RV, Geleris JD, et al. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv, 2017, 10(3): 286-298.
17.	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.
18.	Levy E, Yakubovitch D, Rudis E, et al. The role of combined carotid endarterectomy and coronary artery bypass grafting in the era of carotid stenting in view of long-term results. Interact Cardiovasc Thorac Surg, 2012, 15(6): 984-988.
19.	Kang J, Kim YW, Kim DI, et al. Outcomes of carotid revascularization versus optimal medical treatment alone for asymptomatic carotid stenosis: Inverse-probability-of-treatment weighting using propensity scores. World Neurosurg, 2021, 146: e419-e430.
20.	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.
21.	姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.

1. Beckman JA, Ansel GM, Lyden SP, et al. Carotid artery stenting in asymptomatic carotid artery stenosis: JACC review topic of the week. J Am Coll Cardiol, 2020, 75(6): 648-656.
2. Brunner G, Virani SS, Sun W, et al. Associations between carotid artery plaque burden, plaque characteristics, and cardiovascular events: The ARIC carotid magnetic resonance imaging study. JAMA Cardiol, 2021, 6(1): 79-86.
3. Selwaness M, Bos D, van den Bouwhuijsen Q, et al. Carotid atherosclerotic plaque characteristics on magnetic resonance imaging relate with history of stroke and coronary heart disease. Stroke, 2016, 47(6): 1542-1547.
4. Schermerhorn ML, Liang P, Eldrup-Jorgensen J, et al. Association of transcarotid artery revascularization vs. transfemoral carotid artery stenting with stroke or death among patients with carotid artery stenosis. JAMA, 2019, 322(23): 2313-2322.
5. Beckman JA. Management of asymptomatic internal carotid artery stenosis. JAMA, 2013, 310(15): 1612-1618.
6. Bos D, Arshi B, van den Bouwhuijsen QJA, et al. Atherosclerotic carotid plaque composition and incident stroke and coronary events. J Am Coll Cardiol, 2021, 77(11): 1426-1435.
7. 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.
8. Roffi M, Ribichini F, Castriota F, et al. Management of combined severe carotid and coronary artery disease. Curr Cardiol Rep, 2012, 14(2): 125-134.
9. Manthey S, Spears J, Goldberg S. Coexisting coronary and carotid artery disease: Which technique and in which order? Case report and review of literature. Clin Med Insights Cardiol, 2020, 14: 1179546820951797.
10. 夏琦, 骆晨涛, 林熠, 等. 分期行冠状动脉旁路移植术和颈动脉支架植入术对术前脑卒中患者的临床预后研究. 中国胸心血管外科临床杂志, 2022, 29(5): 565-571.
11. Abbott AL, Paraskevas KI, Kakkos SK, et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke, 2015, 46(11): 3288-3301.
12. Marsman MS, Wetterslev J, Jahrome AK, et al. Carotid endarterectomy with patch angioplasty versus primary closure in patients with symptomatic and significant stenosis: A systematic review with meta-analyses and trial sequential analysis of randomized clinical trials. Syst Rev, 2021, 10(1): 139.
13. Cheng SF, Richards T, Gregson J, et al. Long term restenosis rate after carotid endarterectomy: Comparison of three surgical techniques and intra-operative shunt use. Eur J Vasc Endovasc Surg, 2021, 62(4): 513-521.
14. Santarpino G, Nicolini F, De Feo M, et al. Prognostic impact of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting. Eur J Vasc Endovasc Surg, 2018, 56(5): 741-748.
15. Ogutu P, Werner R, Oertel F, et al. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery? Interact Cardiovasc Thorac Surg, 2014, 18(4): 511-518.
16. Feldman DN, Swaminathan RV, Geleris JD, et al. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv, 2017, 10(3): 286-298.
17. 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.
18. Levy E, Yakubovitch D, Rudis E, et al. The role of combined carotid endarterectomy and coronary artery bypass grafting in the era of carotid stenting in view of long-term results. Interact Cardiovasc Thorac Surg, 2012, 15(6): 984-988.
19. Kang J, Kim YW, Kim DI, et al. Outcomes of carotid revascularization versus optimal medical treatment alone for asymptomatic carotid stenosis: Inverse-probability-of-treatment weighting using propensity scores. World Neurosurg, 2021, 146: e419-e430.
20. 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.
21. 姜兆磊, 汤敏, 梅举, 等. 高龄冠心病合并心房颤动患者行非体外循环冠状动脉旁路移植术中左心耳处理的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(2): 186-190.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

One-stop carotid endarterectomy and off-pump coronary artery bypass grafting for patients with coronary artery disease and carotid artery stenosis

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