HOSPITAL RESULTS OF THE DIFFERENT STRATEGIES OF SURGICAL TREATMENT OF PATIENTS WITH CONCOMITANT CORONARY DISEASE AND INTERNAL CAROTID ARTERIES STENOSES

Purpose. To estimate hospital outcomes of different strategies of surgical treatment of patients with concomitant coronary disease and internal carotid artery (ICA) stenoses.

Methods. In a single-center prospective study included 391 patients with hemodynamically significant coronary artery and internal carotid artery stenoses. All patients were divided into four groups depending on the revascularization strategy: 1) staged surgery – coronary bypass grafting (CABG) followed carotid endarterectomy (CE) (CABG – CE, n=151, 38.6 %); 2) simultaneous surgery CABG and CE (CABG + CE, n=141, 36 %); 3) hybrid revascularization – percutaneous coronary intervention (PCI) and CE (PCI – CE, n=28, 7.2 %); 4) staged surgery – CE followed CABG (CE – CABG, n=71, 18.2 %).

Results. The average age of the patients was 63,4±6,9 (36–83) years. The average EuroScore II in the general study sample – 4,5±2,4 %, while the severity of coronary atherosclerosis on a SYNTAX Score – 22,5±9,4 points. The majority of patients had multiple coronary lesions (n=361, 92.3 %). Every fourth patient had a significant stenosis of the left main coronary artery (n=92, 23.5 %). Bilateral ICA stenosis diagnosed in 60.1 % of patients; 28.1 % of patients had a history of stroke or TIA. Almost one in three patients (29.7 %) had diabetes. Mortality rates in the overall study sample was 2 % (n=8), the majority of cases were reported in CE – CABG group. Perioperative myocardial infarction was recorded in CABG – CE (n=2, 1.3 %) and CABG + CE (n=2, 1.4 %) group, while the other two groups missing this complication (p>0.05). The least favorable for stroke / TIA rate was CE – CABG group, while patients of CABG – CE group had minimal level of this complications. CABG + CE and PCI – CE groups took an intermediate position. The maximum amount of bleeding that required re- mediastinotomy noted in CABG – CE group (n=10, 7.1 %).

Conclusion. Patients with concomitant coronary disease and ICA stenoses have high clinical and instrumental concentration of negative factors, associated with a poor prognosis and require the implementation of various surgical revascularization strategies. Maximum severity of complications was recorded in patients with CE – CABG and CABG + CE revascularization strategy. Despite this, the results of simultaneous surgery are very promising.

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