Abstract
Background: Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a “bridging” protocol for staged CAS-CTS. Methods: A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint. Results: 11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24–288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes. Conclusions: For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.
Original language | English (US) |
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Pages (from-to) | 433-439 |
Number of pages | 7 |
Journal | Vascular |
Volume | 32 |
Issue number | 2 |
DOIs | |
State | Published - Apr 2024 |
Externally published | Yes |
Keywords
- Eptifibatide
- antiplatelet therapy
- carotid stent
- carotid-coronary revascularization
- dual antiplatelet
- endovascular surgery
ASJC Scopus subject areas
- Surgery
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine