Hybrid revascularization of the brain and myocardium: risk stratification for in-hospital complications

Kazantsev A.N.^1,2, Tarasov R.S.¹, Burkov N.N.^1,2, Ganyukov V.I.¹

1) Research Institute for Complex Problems of Cardiovascular Diseases,
2) Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash, Kemerovo, Russia

Objective. The study was aimed at determining efficacy of a new computer program of stratification of the risk for postoperative adverse cardiovascular events in patients with atherosclerotic lesions of coronary and carotid arteries.

Patients and methods. Based on a mathematical analysis of the outcomes of treatment of patients with atherosclerotic lesions of coronary and carotid arteries over the period from 2011 to 2015, we created a program making it possible to determine a staged or simultaneous policy of revascularization, which was retrospectively and prospectively tested in our medical facility.

Results. Within the frameworks of a clinical example we carried out hybrid revascularization of the brain and myocardium in the scope of percutaneous coronary intervention and carotid endarterectomy. During the early postoperative hours, the development of myocardial infarction was registered. According to the program’s calculations, in using other strategies of surgical treatment (carotid endarterectomy + coronary artery bypass grafting and carotid endarterectomy – coronary artery bypass grafting), the level of risk for the development of a complication was lowest. Thus, taking into consideration this risk stratification by a multidisciplinary team made it possible to avoid the development of complications.

Conclusion. This program of decision-making regarding revascularization for atherosclerotic lesions of coronary and carotid arteries may be an additional tool in the armamentarium of the methods of determining therapeutic strategy for this patient cohort.

KEY WORDS: carotid endarterectomy, coronary artery bypass grafting, percutaneous coronary intervention, risk stratification, computer program, myocardial infarction.

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