Simultaneous and staged operations' immediate and long-term results in
patients with the coronary and carotid arteries' combined
atherosclerotic lesions
Abstract
Objective: To study the surgical treatment’s immediate and
long-term results of patients with the coronary and carotid arteries’
combined atherosclerotic lesions when choosing treatment tactics
according to the developed a differentiated approach’s algorithm.
Methods: During the period from 01.07.2014 – 01.01.2021, 243
patients with the coronary and carotid arteries’ combined
atherosclerotic lesions were included in the study. Patients underwent
revascularization operations on the previously developed algorithm’s
basis for choosing the surgical intervention’s volume and stage. 104
patients (42.8%) underwent simultaneous combined coronary artery bypass
grafting (CABG) and carotid endarterectomy (CEA), 139 (57.2%) patients
received phased revascularization, of which 102 (73.4%) patients
underwent CABG, 37 (26.6%) underwent CEA in the first stage. The
endpoints both when comparing immediate and long-term results were:
death from all causes, acute cerebrovascular accident (ACVA), transient
ischemic attack (TIA), acute myocardial infarction (MI), as well as a
combined endpoint that includes all of these events. Average follow-up
time: 41.1±21.8 months. Results: In the early postoperative
period, there weren’t fatal cases in any groups. At the hospital stage,
5 (2.1%) ACVA cases, 1 (0.4%) TIA case and 3 (1.2%) acute MI cases
were recorded. Long-term results were evaluated in 225 patients
(92.3%). The overall survival rate was 93.8%. During the follow-up, 5
(2.4%) MI cases, 11 (4.9%) ACVA cases , 1 (1.0%) TIA case were
recorded. There weren’t identified significant differences between the
groups stage and combined interventions for any endpoints as when
comparing the immediate outcomes (acute IM p=0,680, TIA – p=0,500, ACVA
– p=0,567, combined indicator, p=0,940) and remote results (mortality
– 0,860, acute MI – p=0,906, TIA – p=0,528, ACVA – p=0,378, combined
indicator, p=0,669). Conclusion: The treatment’s results of
patients with the coronary and brachycephalic arteries’ combined
atherosclerosis on the developed algorithm’s basis, allows you to safely
perform correction in both arterial basins and achieve satisfactory
results in the hospital and long-term period.