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(Stroke. 2006;37:1153-a.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Compatibility of Carotid Stenting and Cardiac Surgery

University of Milan, Milan, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the study by Randall et al¹ describing their experience on carotid artery stenting before cardiac surgery. They present 19.2% combined minor stroke, major stroke and death rate, which appears to be higher than previously documented in the literature, as they admit.

The only published trial (investigation performed by the same authors)² comparing dual antiplatelet regime versus aspirin alone for carotid artery stenting was prematurely interrupted for excess of benefit on the dual antiplatelet arm of the study, confirming the necessity of dual antiplatelet regime before, during and after carotid artery stenting. Stent endothelialization takes between 28 and 96 days.³ During this time the exposed metallic stent continuous to act as a source of platelet activation² so the dual antiplatelet regime benefits may be explained on the basis of the limitation of this phenomenon.

It is also well known that antiplatelet drugs increase bleeding complications during cardiac surgery, and dual antiplatelet regimes could increase furthermore the risk of bleeding in the perioperative period.

Consequently, in our opinion the 2 procedures are not compatible in their optimal version and compromise is inevitable. That is, the cardiac surgeon must decide to interrupt dual antiplatelet regime for the intervention to minimize bleeding complications, but increasing the risk of neurological adverse events, or perform the operation under dual antiplatelet regime reducing the risk of perioperative stroke, but increasing perioperative bleeding complications.

The third solution, the delay of the cardiac procedure to permit stent endothelialization and a less . . . [Full Text of this Article]

Marc Randall, MRCP; Fiona McKevitt, MD, MRCP Graham Venables, DM, FRCP

Neurology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, National Health Service Foundation Trust

Trevor Cleveland, FRCS, FRCR Peter Gaines, FRCP, FRCR

Sheffield Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals, National Health Service Foundation Trust