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Simultaneous Hybrid Revascularization by Carotid Stenting and Coronary Artery Bypass Grafting

The SHARP Study

Francesco Versaci, MD^_*, Bernhard Reimers, MD, Costantino Del Giudice, MD, Joachim Schofer, MD^||, Alessandro Giacomin, MD, Salvatore Saccà, MD, Roberto Gandini, MD, Remo Albiero, MD^¶, Antonio Pellegrino, MD, Fabio Bertoldo, MD, Giovanni Simonetti, MD, Luigi Chiariello, MD^,_*

^_* Divisione di Cardiologia, Università Tor Vergata, Rome, Italy
Divisione di Cardiochirurgia, Università Tor Vergata, Rome, Italy
Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Università Tor Vergata, Rome, Italy
Dipartimento Cardiovascolare, Ospedale Civile di Mirano, Venice, Italy
^|| Heart Center, Hamburg, Germany
^¶ Clinica San Rocco di Franciacorta, Ome (Brescia), Italy

^_* Reprint requests and correspondence: Dr. Luigi Chiariello, Cattedra di Cardiochirurgia, Università di Roma Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81-00133 Rome, Italy (Email: lchiariello{at}tiscali.it).

Objectives: In an attempt to reduce post-operative events we investigated a new therapeutic strategy consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by an on-pump coronary artery bypass graft (CABG).

Background: Preventing stroke and cardiovascular events after coronary artery revascularization in patients with elevated surgical risk is a complex and multifaceted problem.

Methods: One hundred-one consecutive patients with severe carotid and coronary artery disease and a standard EuroSCORE 5 were included in this multicenter study. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, acute myocardial infarction (AMI), or death at 30 days. Secondary outcomes were transient ischemic attacks; major local complications; bleeding and systemic complications within 30 days after treatment; and any stroke, AMI, or death occurring from the 31st day to the end of the 12-month follow-up. All clinical outcomes were assessed by an independent monitoring board.

Results: The rate of procedural success was 98%. The 30-day cumulative incidence of disabling stroke, AMI, or death was 4%: 2 patients died (2%) in the post-operative period, and 2 patients (2%) had a stroke immediately after CAS and before CABG. Three patients died from the 31st day to the 12th month after the procedure.

Conclusions: Our findings indicate that in high-risk patients with coronary artery disease suitable for CABG and carotid artery disease, the hybrid revascularization by CAS immediately followed by CABG is a promising and feasible therapeutic strategy.

Key Words: carotid arteries • coronary artery bypass grafts • new technology • stents • surgery complications

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CAD = coronary artery disease   CAS = carotid artery stenting   CEA = carotid endarterectomy   CT = computed tomography   EuroSCORE = European system for cardiac operative risk evaluation   TIA = transient ischemic attack

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