Long-term outcomes of myocardial and cerebral revascularization with combined or staged percutaneous interventions and carotid endarterectomy

Aim To evaluate in-hospital and long-term outcomes of myocardial and cerebral revascularization with combined or staged PCI and carotid endarterectomy.

Methods.263 myocardial and cerebral revascularizations with PCI and CEA in patients with combined cerebral and coronary artery lesions in the period from 2011 to 2017 were performed. Patients were divided into two groups depending on the surgical strategy. Patient (n = 133) who underwent a staged intervention (CEA and PCI) were included in Group 1, whereas patients (n = 130) who underwent a hybrid intervention (CEE+PCI CA) were included in Group 2. The mean follow-up was 3.5 years.

Results.100% of patients in Group 2 underwent coronary and internal carotid revascularization according to the results of in-hospital and long-term follow-up. 81.35% of patient in Group 1 underwent PCI and CEA, whereas 3.01% of patients underwent only PCI and 6.77% of patients – CEA. 1.5% of patients in Group 1 did not receive any surgical treatment. The most common causes of incomplete revascularization were the subsequent change of the initially defined treatment for myocardial (6.02%) or cerebral revascularization (0.75%). The rest refused the second stage, or it was associated with extremely high risk and the strategy was switched to the conservative therapy.

Conclusion.100% of patients received hybrid myocardial and cerebral revascularization during one hospitalization. It allowed reducing mortality from MI and stroke during the waiting period for the next stage of the treatment in Group 1 (almost 5%). Hybrid interventions can be used in patients with high risk for open-heart surgery, severe comorbidities (obesity, diabetes, renal dysfunction), significant coronary and cerebral artery lesions with high risk of MI and stroke. However, hybrid approach was associated with high rate (almost 7%) of non-fatal MI in the long-term follow-up.

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