Subject(s)
Arteriovenous Fistula/diagnostic imaging , Cardiomyopathy, Dilated/surgery , Heart Transplantation/adverse effects , Postoperative Complications/diagnostic imaging , Adult , Coronary Angiography , Coronary Vessels/diagnostic imaging , Humans , Male , Pulmonary Artery/diagnostic imaging , Radionuclide Ventriculography , Ventriculography, First-PassSubject(s)
Cardiac Catheterization/methods , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Vascular Closure Devices , Adult , Cardiac Catheterization/instrumentation , Female , HumansSubject(s)
Embolism, Paradoxical/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Embolism, Paradoxical/complications , Foramen Ovale, Patent/complications , Humans , Male , Middle Aged , Myocardial Infarction/etiologySubject(s)
Antibodies, Antiphospholipid/blood , Antiphospholipid Syndrome , Endocarditis, Non-Infective , Stroke , Warfarin/administration & dosage , Adult , Anticoagulants/administration & dosage , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/immunology , Antiphospholipid Syndrome/physiopathology , Antiphospholipid Syndrome/therapy , Chemoprevention/methods , Diagnosis, Differential , Disease Management , Echocardiography, Transesophageal/methods , Endocarditis, Non-Infective/diagnosis , Endocarditis, Non-Infective/etiology , Female , Humans , Immunologic Tests/methods , Magnetic Resonance Imaging/methods , Platelet Aggregation Inhibitors/administration & dosage , Stroke/diagnosis , Stroke/etiology , Stroke/prevention & control , Treatment OutcomeABSTRACT
The objective of this study was to assess the clinical course of patients undergoing planned percutaneous carotid stenting followed by staged coronary artery bypass grafting (CABG). Coexisting carotid and coronary atherosclerotic disease is relatively common. A combined or staged surgical approach has a composite stroke, myocardial infarction, or death rate of > 10%. We performed a retrospective search of our single-institution database to identify all patients scheduled to undergo staged carotid stenting followed by CABG. Twenty-three such patients (17 males, 6 females) were identified, with 3/23 (13%) requiring bilateral carotid stenting. Most carotid lesions were asymptomatic (18/26; 69.2%) and severe (mean stenosis, 82.9% 6+/- 8.6%). Stents were successfully placed in 26/26 carotid arteries (100%). One stent procedure (1/26; 3.8%) resulted in a minor stroke, but full recovery occurred within 1 week. There were no other peri-stenting complications. Three patents (3/23; 13%), none of whom suffered an adverse event at carotid stenting, elected not to undergo CABG. The mean interval from last carotid stent to CABG was 69.6 6 +/- 39.6 days (range, 8-157 days). Antiplatelet therapy was ceased > 3 days prior to CABG in 10/20 patients (50%), but continued until surgery in the remainder. There were no peri-CABG bleeding or neurological complications, but one myocardial infarction occurred (1/20; 5%). Therefore, of the 20 patients who underwent planned carotid stenting followed by CABG, our overall rate of death, stroke, or myocardial infarction was 10%. However, our rate of death, persistent stroke or myocardial infarction was 5%. Planned carotid stenting followed by staged CABG is a viable method of treatment for patients with coexistent carotid and coronary atherosclerosis.
Subject(s)
Coronary Artery Bypass , Coronary Disease/epidemiology , Coronary Stenosis/epidemiology , Coronary Stenosis/therapy , Stents , Aged , Comorbidity , Coronary Artery Bypass/methods , Coronary Disease/surgery , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Stroke/epidemiologyABSTRACT
We present two cases of successful, emergency renal artery stenting in the setting of acute renal failure requiring dialysis secondary to renal artery stenosis. Early reopening of the stenotic renal artery led to the resolution of acute renal failure and obviated the need for further dialysis in both cases.