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Synchronous versus staged carotid artery stenting and cardiac surgery – a unicentric study
Session:
Posters (Sessão 6 - Écran 2) - Intervenção não coronária
Speaker:
Ana L. Silva
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana L. Silva; João Gameiro; Gonçalo Terleira Batista; Mariana Rodrigues Simões; Tatiana Pereira Dos Santos; José Luís Martins; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><strong>Introduction:</strong> Carotid stenosis is a known risk factor for stroke after cardiac surgery, with up to 22% in-hospital mortality. The best approach to treat concomitant carotid and cardiac disease remains controversial.</p> <p style="text-align:justify"><strong>Methods:</strong> Single-center, retrospective study. Patients referred to cardiac surgery who underwent synchronous or staged carotid artery stenting (CAS) from 2000 to 2022 were included. Our aim was to assess and compare the prognosis between the synchronous versus staged strategy of CAS in patients undergoing cardiac surgery. The composite of myocardial infarction (MI), stroke and death at 30 days, and all-cause mortality at one year were evaluated. Statistical analysis was performed using SPSS 28.0.1.1 software.</p> <p style="text-align:justify"><strong>Results:</strong> A total of 151 patients were included (67 and 84 patients did the synchronous and the staged approaches, respectively). The mean age (±SD) of the population was 72,2 (±7,7) years old, 80% men. There was a significant prevalence of arterial hypertension (93,4%), dyslipidemia (80,1%), diabetes (37,7%), and smoking background (29,8%). Two statistically significant differences were found in the baseline clinical characteristics: a higher percentage of patients with dyslipidemia (91,0% vs. 71,4%; p=0,003) and smoking background (38,8% vs. 22,6%; p=0,031) in the synchronous group.</p> <p style="text-align:justify">During the 30-day follow-up, the combined endpoint of stroke, MI, or death (MACE) occurred in 7,5% of patients in the synchronous group and 6,0% in the staged group, with no statistically significant difference (p=0,751). The perioperative mortality rate was lower in the synchronous group (1,5%) compared to the staged group (3,7%), though this difference did not reach statistical significance (p=0,630). The incidence of stroke was similar in both groups (3,1% vs. 2,4% in the synchronous and staged groups, respectively; p=1,000). Regarding MI, the incidence in the synchronous group was 3,1%, in contrast with no events detected in the staged group (statistical analysis not possible to compute).</p> <p style="text-align:justify">The 1-year mortality rate was also assessed. Synchronous and staged groups showed a mortality rate of 9,1% and 6,0%, respectively, with no statistically significant difference (p=0,539).</p> <p style="text-align:justify"><strong>Conclusion:</strong> The synchronous approach appears to be an appropriate option to manage carotid disease in patients who need heart surgery since the perioperative risk of death, stroke, and the 1-year mortality rate are comparable with the staged procedure. The higher prevalence of dyslipidemia and smoking background in the synchronous group denotes these patients' high-risk profile, who generally need prompt cardiac intervention.</p>
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