[Carotid endarterectomy in patients with ACS: retrospective analysis of the results of a staged and simultaneous approach].

Abstract

Background: In modern articles contains many studies devoted to various surgical treatment strategies for concomitant coronary and carotid artery disease. However, all studies address this issue only in patients with stable coronary artery disease and do not provide any recommendations on strategies for patients with ACS who are diagnosed with significant carotid artery stenosis be for interventions. Therefore, the decision on a specific approach is left to the discretion of the cardiac team at individual clinics. The aim of our study was to evaluate the results of a staged and simultaneous approach to surgical treatment in patients with significant coronary artery stenosis and acute coronary syndrome.

Material and methods: From January 2014 to October 2025, 10 447 patients with ACS were treated in our Center, of which 1423 (13.6%) underwent CABG. Retrospectively, with a continuous sample, 188 (13.2%) patients were included in study with concomitant stenosis carotid and coronary basins. In 134 (71.3%) cases was performed staged intervention and in 54 cases (28.7%) was simultaneous intervention. The average age of patients in the groups was 65.4±7.4 and 64.2±7.4 years (p=0.292). The study was dominated by men (70.7%). The average number of affected vessels was 3.2±0.9. Overall EuroSCORE II was 5.7±2.8% Results. Mortality in the groups no differ 2.9 and 5.5% (p=0.396). The groups no differ in the conditions of the surgery: on pump, off pump. Also, the groups no differ in surgery-related complications. Simultaneous group statistically stayed longer in the intensive care unit p<0.05. The average follow-up period for the group of staged and simultaneous interventions was 67 and 59.5 months, respectively. The 5-year survival rate was 90.8 and 89.2% (Log-rank test, p=0.332). Freedom from AMI at 5 years was 89.6 and 91.3% (Log-rank test, p=0.545). Freedom from stroke at 5 years was 94.2 and 93.8% (Log-rank test, p=0.386). Freedom from re-interventions at 5 years was 89.6 and 91.3% (Log-rank test, p=0.545).

Conclusion: Rational choice of surgical treatment strategy, strict adherence to the internal protocol for selection of high-risk surgical patients with combined of carotid and coronary arteries lesions, allows for staged and simultaneous interventions with an acceptable risk of mortality and complications in an experienced center.