One stage carotid artery stenting and open heart surgery: a novel approach.

AIM: The optimal management of the patients requiring cardiac surgery with simultaneous severe carotid disease remains controversial. The traditional approach involves staged or combined carotid endarterectomy and cardiac surgery. This study evaluated the feasibility and safety of angioplasty and stenting for the treatment of carotid stenoses combined with cardiac operations in order to reduce the risk of perioperative stroke. METHODS: In a prospective, non-randomized study, we analyzed 70 consecutive patients requiring cardiac surgery with simultaneous severe carotid artery disease that underwent carotid artery stenting (CAS) and cardiac surgery in one stage. Symptomatic patients with ≥ 60% carotid stenosis, and asymptomatic patients with ≥ 70% stenosis, were treated using CAS under local anesthesia immediately before the open heart surgery. Cerebral protection devices were used in all cases. RESULTS: Despite the high baseline risk profile, our results were very encouraging. Carotid stenting was successful in all patients. No neurological complications occurred during the carotid stenting procedures. The 30-day death/stroke rate was 1.4% (no deaths, 1 contralateral minor stroke). No myocardial infarctions occurred. The carotid restenosis rate was zero during the long-term follow up. CONCLUSION: The low complication rate suggests that CAS and cardiac surgery in one stage offers a safer therapeutic option compared to combined carotid endarterectomy and cardiac surgery. It may also be safer than with the staged CAS and coronary artery bypass grafting approach as well.

ProCol vascular bioprosthesis for vascular access: midterm results.

BACKGROUND/AIMS: This study aimed to evaluate the safety and efficacy of the ProCol vascular bioprostheses as vascular access (VA) material, especially in patients with a history of prior failed access. METHODS: During a 20-month period, 25 arteriovenous (AV) bovine vein grafts were placed in 24 hemodialysis (HD) patients for VA. All patients presented with failed autologous access sites. RESULTS: Graft placement was successful in all patients with no procedure-related complications. Follow-up from 6-26 months gave primary 6-month, 12-month and 24-month patency rates of, respectively, 90%, 80% and 70%. Graft characteristics in cannulation and hemostasis were very satisfying. CONCLUSION: Our midterm results demonstrated that the ProCol vascular bioprosthesis was a promising material for VA with good patency and low complication rates.

Stenting of central venous stenoses and occlusions to maintain hemodialysis vascular access.

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of stenting for the treatment of central arm vein obstructions in hemodialysis patients in order to maintain hemodialysis from the affected side. METHODS: Fifteen self-expanding (8) and balloon expandable (7) stainless steel stents were implanted in 10 hemodialysis patients for the treatment of symptomatic central arm vein obstructions. Thirteen lesions were treated: 6 subclavian, 4 innominate and 3 restenoses. RESULTS: Stent deployment was successful in all cases leading to resolution of symptoms by correcting the underlying cause of venous hypertension. Follow-up from 3 months to 4 years revealed four deaths from unrelated causes, three restenoses at 1, 3, 4 months and one occlusion at 6 months respectively for a cumulative primary one-year and two-year patency rate of 70%. CONCLUSION: Stenting of subclavian and innominate venous stenoses and occlusions effectively corrected the underlying lesions responsible for disturbed hemodynamics and, in most cases, prolonged available hemodialysis access from the affected side.