HYBRID REVASCULARIZATION BY MEANS OF CAROTID ENDARTERECTOMY AND PERCUTANEOUS CORONARY INTERVENTION: THIRTEEN-YEAR PATH OF TECHNOLOGY DEVELOPMENT

Highlights

• Hospital data of patients who received revascularization of the brain and myocardium in the scope of carotid endaratherectomy and percutaneous coronary intervention were analyzed.
• The development of hybrid revascularization technology in terms of carotid endaratherectomy and percutaneous coronary intervention over the course of thirteen years has been analyzed.

Absract

Aim. To study the in-hospital outcomes of hybrid intervention in the volume of percutaneous coronary intervention and carotid endarterectomy in the context of thirteen-year dynamics of this technology in patients with severe atherosclerosis of the coronary and carotid bed.

Methods. From 2011 to 2023, 301 hybrid interventions (PCI + CEE) were performed in patients with combined significant lesions of the coronary and internal carotid arteries at the Kuzbass Cardiology Center. The choice of treatment strategy for patients was carried out by a multidisciplinary team involving a cardiologist, cardiovascular surgeon, endovascular surgeon and angioneurologist based on current clinical guidelines, local treatment protocols and a personalized approach. The study assessed the clinical, anatomical-angiographic and perioperative status of patients. In-hospital endpoints included death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, and repeated unplanned myocardial or cerebral revascularization.

Results. No fatal outcomes were identified in the analysis of the total sample of patients in the hospital period. The incidence of myocardial infarction was 2.3%, stroke – 2%, unplanned repeat myocardial revascularization – 0.7%, and bleeding – 2.4%. When comparing the two groups (2011–2017 and 2018–2023), no fatal outcomes were recorded in either group. The highest number of MIs was recorded in the early period of hybrid technology implementation (3.08% versus 1.8%). The frequency of repeated unplanned myocardial revascularization in the first group (early period) was slightly higher (1.54% versus 0%). However, in terms of the frequency of stroke, the second group (late period) was in the lead (0% versus 3.5%). In this regard, the final combined (MACE) point in the second group was higher (3.08% versus 5.3%).

Conclusion. Thus, hybrid myocardial and cerebral revascularization in the volume of PCI and CEE is a promising and safe method for treating patients with multifocal atherosclerosis, characterized by an extremely low probability of hospital mortality, and satisfactory indicators of the risks of other adverse cardiovascular events (MI and stroke). The implementation of the hybrid treatment strategy eliminates the risks of patient no-show at the second stage of revascularization for subjective and objective reasons, reduces the likelihood of a cardiovascular catastrophe while waiting for the second stage of treatment. Thirteen years of implementation of this technology in a single center demonstrates stable, sustainable and encouraging hospital outcomes and complication risks depending on the initial characteristics of patients.

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