| Part 1:Prevalence of Extracranial Carotid Artery Stenosis in Chinese Patients with Angina PectorisBackground:The prevalence of carotid artery stenosis(CAS)in Chinese patients with angina pectoris is unknown.Methods:The study population consisted of 989 consecutive patients who were scheduled to undergo nonemergent coronary angiography for suspicion of coronary artery disease(CAD)because of angina pectoris between January 2013 and December 2014.All patients underwent carotid ultrasonography to screen for CAS within one month before or after coronary angiography.We defined cases with 0-50%,50%-70%,and>70%stenosis as mild,moderate,and severe stenosis,respectively.Results:CAD was presented in 853 patients(86.2%)of whom 191 patients(19.3%)had 1-vessel disease,246 patients(24.9%)had 2-vessel disease and 416 patients(42.1%)had 3-vessel disease;left main trunk stenosis present in 137 patients(13.9%).In carotid ultrasonography,the prevalence of mild,moderate,and severe stenosis as well as that of total occlusion of the carotid artery was 54.5%,13%,4.7%and 0.8%,respectively.Significant CAS(>50%stenosis and total occlusion)was present in 10.3%,13.9%,19.9%and 22.8%of patients with 0-vessel,1-vessel,2-vessel and 3-vessel CAD.The severity of CAS was directly correlated(r=0.194,P<0.001)with the extent of CAD.The independent predictors of severe CAS and total carotid artery occlusion were increased age,male sex,hypertension,diabetes mellitus,hyperhomocysteinemia,a previous history of stroke and 3-vessel CAD.Conclusions:The prevalence of CAS was not rare in China when compared with that in western countries,and the presence of CAS was weakly correlated with the extent of CAD.Screening for CAS should be recommended in Chinese patients with CAD,especially in those with one or more CAS-associated risk factors.Part 2:Efficacy of Carotid Endarterectomy and Stenting in Simultaneous Carotid and Coronary Artery RevascularizationObjective:To evaluate the efficacy of carotid endarterectomy and stenting in simultaneous carotid and coronary artery revascularization.Methods:Retrospectively analyze the clinical data of 38 patients with simultaneous carotid and coronary artery revascularization in China-Japan Friendship Hospital from January 2008 to December 2014.The clinical characteristics,imageological examination,treatment and prognosis were reviewed.According to the technique of carotid revascularization,the patients were classified into CEA group(31 cases)and CAS group(7 cases).The relevant clinical variables were analyzed and compared between the 2 groups.Results:The mean operative time of CEA and CAS group were 294.68±48.18 min and 260.71±44.94 min,respectively.The mean blood loss of CEA and CAS group were 770.97±344.67 mL and 628.57±236.04 mL,respectively.The difference of operative time and blood loss between the 2 groups were both not significant.3 minor stroke,4 TIA,2 pulmonary infections and 3 recurrent laryngeal nerve injury were observed in CEA group.1 TIA and 1 re-thoracotomy for hemostasis occurred in CAS group.No peri-operative myocardial infarction and death occurred in both groups.Conclusion:Both carotid endarterectomy and carotid stenting were safe and reliable in simultaneous carotid and coronary artery revascularization.The proper technique of carotid artery revascularization should be chosen according to the characteristics of each patient.Part 3:A Systematic Review of Early Results Following Synchronous or Staged Carotid Artery Stenting and Coronary Artery Bypass GraftingBackground:The optimal management of patients with concomitant coronary artery disease(CAD)and severe carotid artery stenosis remains a controversy.We performed a systematic review of studies comparing early outcomes of synchronous or staged carotid artery stenting(CAS)and coronary artery bypass grafting(CABG)in the treatment of patients with concomitant CAD and severe carotid artery stenosis.Methods:Multiple databases were systematically searched to identify studies of synchronous or staged CAS and CABG in the treatment of concomitant severe carotid and coronary artery disease published from 2005 to 2015.The quality of studies was assessed using the MINORS scale.The demographic data,risk factors,30-day outcomes,and antiplatelet strategy were extracted.Results:23 studies were identified with a total of 873 and 459 patients in the staged and synchronous group,respectively.The observed overall death/stroke/MI rate was 8.5%(95%CI:1,6-9.4%)in staged group and 4.8%(95%CI:3.8-5.8%)in synchronous group.It seems that the synchronous group has better 30-day outcomes,but these data could not be compared statistically.Conclusion:Our systematic review suggests either synchronous or staged CAS and CABG can be chosen for the treatment of concomitant carotid and coronary artery disease.It seems that the synchronous approach is relatively convenient and the antiplatelet strategy is relatively definite.For these patients,hybrid revascularization by synchronous CAS and CABG might be a feasible and promising therapeutic strategy.Our conclusions and the quality of the existing data suggest that a randomized controlled trial is needed to define the best treatment for patients with concomitant carotid and coronary artery disease. |
PDF Full Text Request