Simultaneous Hybrid Revascularization with Carotid Stenting and Coronary Artery Bypass Grafting: Long-term Results of the SHARP Study

We have recently introduced a new therapeutic strategy (“SHARP protocol”) consisting of a simultaneous hybrid revascularization by carotid artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG) with the aim to reduce operative risk and minimize surgical trauma as compared to traditional approaches. Ninety-five consecutive patients (mean age 68.87.8 years, 79 males,) underwent simultaneous CAS-CABG from January 2005 to July 2013 for treatment of concomitant critical (>70% stenosis) carotid and multivessel coronary artery obstructive disease. In-hospital mortality was 2.1%, perioperative myocardial infarction 0%, CAS periprocedural stroke 0%, TIA 3.2%. Actuarial 9-year survival was 8210%. Freedom from cardiac death was 962%, from myocardial infarction 953%, from neurological events 907%, from CAS procedure-related stroke 100%. The proposed hybrid approach confers a mortality rate comparable to that of isolated CABG; CABG immediately following CAS minimizes the risk of periprocedural myocardial infarction. At a long-term period a high rate of event-free survival and freedom from neurological events can be expected using the SHARP protocol.