Asymptomatic carotid stenosis in patients undergoing major cardiac surgery: can percutaneous carotid angioplasty be an alternative?

OBJECTIVE: As the mortality associated with coronary artery bypassgrafts has fallen, morbidity has become an increasing problem. Theimprovement of transluminal carotid angioplasty is enlarged to patientswith asymptomatic severe carotid stenosis (> 85%) requiring coronarysurgery. METHODS: Between January 1993 and January 1995, 10 patientsunderwent percutaneous carotid angioplasty prior to cardiac surgery (17.4days). Mean age was 71 +/- 4.3 years. Four patients showed a contralateralocclusion of the internal carotid artery. Transluminal carotid angioplastywas carried out with a triple coaxial catheter system. Six angioplastiesrequired a Strecker stent. RESULTS: Mean follow-up was 11.4 months. Nomortality was observed. Only one patient showed a transient hemianopsia.All patients underwent angiography at four months. Two patients required anew procedure of carotid angioplasty completed with a Strecker stent in onecase and by dilatation of a stent in another patient. CONCLUSION: Theresults of transluminal carotid angioplasty, in this short series, areencouraging in this group of high-risk morbidity and mortality (elderlypatients, bilateral carotid lesions, multiple coronary arterialgrafts).