What Is the Best Approach to Carotid Revascularization with Open Heart Surgery?

In a single-center study, outcomes of three common approaches varied according to the particular endpoint and the duration of follow-up.

In the absence of randomized-trial data, controversy persists regarding the optimal strategy for carotid revascularization in the context of open heart surgery (OHS). Common approaches include staged carotid endarterectomy (CEA) followed by OHS, CEA plus OHS under single anesthesia, and staged carotid artery stenting (CAS) followed by OHS. In a single-center, observational study lasting 12 years, researchers compared staged CEA–OHS (45 patients), combined CEA–OHS (195 patients), and staged CAS–OHS (110 patients).

The groups had roughly similar baseline characteristics. The median interval for staged procedures was 14 days for CEA–OHS and 47 days for CAS–OHS; before OHS, 12 events occurred in these patients. The incidence of interstage myocar…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)