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1. Combined Treatment With Carotid Endoarterectomy and Coronary Artery Bypass Grafting: A Single-Institutional Experience in 222 Patients

Author

Modugno, Pietro, Picone, Veronica, Centritto, Enrico Maria, Calvo, Eugenio, Canosa, Carlo, Piancone, Felice, Testa, Nicola, Camposarcone, Nicola, Castellano, Gaetano, Astore, Pasquale, Di Martino, Luigi, Di Iusto, Fabrizio, De Filippo, Carlo Maria, Massetti, Massimo, Massetti, Massimo (ORCID:0000-0002-7100-8478), Modugno, Pietro, Picone, Veronica, Centritto, Enrico Maria, Calvo, Eugenio, Canosa, Carlo, Piancone, Felice, Testa, Nicola, Camposarcone, Nicola, Castellano, Gaetano, Astore, Pasquale, Di Martino, Luigi, Di Iusto, Fabrizio, De Filippo, Carlo Maria, Massetti, Massimo, and Massetti, Massimo (ORCID:0000-0002-7100-8478)

Abstract

Introduction Carotid atherosclerotic disease is a known independent risk factor of post operative stroke after coronary artery bypass grafting (CABG). The best management of concomitant coronary artery disease and carotid artery disease remains debated. Current strategies include simultaneous carotid endoarterectomy (CEA) and CABG, staged CEA followed by CABG, staged CABG followed by CEA, staged transfemoral carotid artery stenting (TF-CAS) followed by CABG, simultaneous TF-CAS and CABG and transcarotid artery stenting. Methods We report our experience based on a cohort of 222 patients undergoing combined CEA and CABG surgery who come to our observation from 2004 to 2020. All patients with >70% carotid stenosis and severe multivessel or common truncal coronary artery disease underwent combined CEA and CABG surgery at our instituion. 30% of patients had previously remote neurological symptoms or a cerebral CT-scan with ischemic lesions. Patients with carotid stenosis >70%, either asymptomatic or symptomatic, underwent CT-scan without contrast media to assess ischemic brain injury, and in some cases, if necessary, CT-angiography of the neck and intracranial vessels. Results The overall perioperative mortality rate was 4.1% (9/222 patients). Two patients (.9%) had periprocedural ipsilateral transient ischemic attack (TIA) which completely resolved by the second postoperative day. Two patients (.9%) had an ipsilateral stroke, while 7 patients (3.2%) had a stroke of the controlateral brain hemisphere. Two patients (.9%) patients were affected by periprocedural coma caused by cerebral hypoperfusion due to perioperative heart failure. There were no statistically significant differences between patients in Extracorporeal Circulation (ECC) and Off-pump patients in the onset of perioperative stroke. Conclusion Our experience reported that combined surgical treatment of CEA and CABG, possibly Off-Pump, is a feasible treatment procedure, able to minimize the risk of post

Published
2022

2. Combined Treatment With Carotid Endoarterectomy and Coronary Artery Bypass Grafting: A Single-Institutional Experience in 222 Patients

Author

Pietro Modugno, Veronica Picone, Enrico Maria Centritto, Eugenio Calvo, Carlo Canosa, Felice Piancone, Nicola Testa, Nicola Camposarcone, Gaetano Castellano, Pasquale Astore, Luigi Di Martino, Fabrizio Di Iusto, Carlo Maria De Filippo, and Massimo Massetti

Subjects
Carotid Artery Diseases, Endarterectomy, Carotid, coronary artery bypass grafting, Coronary Artery Disease, General Medicine, Stroke, carotid, Treatment Outcome, Humans, Carotid Stenosis, Stents, Surgery, Coronary Artery Bypass, Cardiology and Cardiovascular Medicine, Settore MED/23 - CHIRURGIA CARDIACA, coronary
Abstract

Introduction Carotid atherosclerotic disease is a known independent risk factor of post operative stroke after coronary artery bypass grafting (CABG). The best management of concomitant coronary artery disease and carotid artery disease remains debated. Current strategies include simultaneous carotid endoarterectomy (CEA) and CABG, staged CEA followed by CABG, staged CABG followed by CEA, staged transfemoral carotid artery stenting (TF-CAS) followed by CABG, simultaneous TF-CAS and CABG and transcarotid artery stenting. Methods We report our experience based on a cohort of 222 patients undergoing combined CEA and CABG surgery who come to our observation from 2004 to 2020. All patients with >70% carotid stenosis and severe multivessel or common truncal coronary artery disease underwent combined CEA and CABG surgery at our instituion. 30% of patients had previously remote neurological symptoms or a cerebral CT-scan with ischemic lesions. Patients with carotid stenosis >70%, either asymptomatic or symptomatic, underwent CT-scan without contrast media to assess ischemic brain injury, and in some cases, if necessary, CT-angiography of the neck and intracranial vessels. Results The overall perioperative mortality rate was 4.1% (9/222 patients). Two patients (.9%) had periprocedural ipsilateral transient ischemic attack (TIA) which completely resolved by the second postoperative day. Two patients (.9%) had an ipsilateral stroke, while 7 patients (3.2%) had a stroke of the controlateral brain hemisphere. Two patients (.9%) patients were affected by periprocedural coma caused by cerebral hypoperfusion due to perioperative heart failure. There were no statistically significant differences between patients in Extracorporeal Circulation (ECC) and Off-pump patients in the onset of perioperative stroke. Conclusion Our experience reported that combined surgical treatment of CEA and CABG, possibly Off-Pump, is a feasible treatment procedure, able to minimize the risk of post-operative stroke and cognitive deficits.

Published
2022

3. Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l'anziano - a computerized network on health care services for older people)

Author

Lattanzio F, Mussi C, Scafato E, Ruggiero C, Dell'Aquila G, Pedone C, Mammarella F, Galluzzo L, Salvioli G, Senin U, Carbonin PU, Bernabei R, Cherubini A, Laguzzi E, Cucinotta D, Arnone G, Rozzini R, Cassinadri A, Putzu P, Porceddu C, Zaru C, Abate G, Di Iorio A, Abate M, Guglielmi M, Foschini N, Battaglini C, Fellin R, Volpato S, Cavalieri M, Fotini S, Guerra G, Rossi L, Masotti G, Fumagalli S, Odetti P, Cataldi A, Monacelli F, Nicita Mauro V, Basile G, Maltese G, Nicita Mauro C, Pellicciotti F, Scotto R, Vaccina A, Minnucci A, Forte L, Lo Storoto MR, Licata G, Tuttolomondo A, Barbagallo M, Dominguez LJ, De Leo M, Belvedere M, Putignano E, Longo A, Mancioli G, Patacchini F, Palmari N, Ierardi BA, Marino P, Soldato M, Pilotto A, Paris F, Forconi S, Guerrini M, De Paduanis GA, De Palma A, Boschi S, Molaschi M, Poli L, De Colle P, Bonoldi G, Puricelli S, Pellegrini R, Consolaro E, Bosello O, Zivelonghi A, Gravic G, Guariento S, Di Francesco V, Tua E, Pisaturo A, Lacava R, Gareri P, Borgia R, Cristiano VN, Palummeri, Pescetelli, Galdi M, Bochicchio GB, Solimano A, Brugaletta S, Carnazza L, Gallitto E, Albano G, Schipani G, Conte, Pagella A, Perrero L, Sabato V, Marella L, Schiavina, Zacco B, Scaglia L, Virgilio A, Iera M, Doria, Pansini L, Boni N, Inzitari M, Aramini I, Musante S, Cavagnaro P, Riello F, De Alfieri W, Pescetelli P, Trecca R, Di Iusto, Zamboni V, Cuppone R, Foschi, Marino S, Simone M, Scarlata A, Battegazzore C, Morucci R, Luchetti M, Menculini G, Cichetti G, Orlando I, Fantoni B, Ognibene G, Gobbi C, Cascone A, Avanzi GL, Casu A, Zeni S, Santin S, Scotti G, Cappella C, Penzo P., TOIGO, GABRIELE, Lattanzio, F, Mussi, C, Scafato, E, Ruggiero, C, Dell'Aquila, G, Pedone, C, Mammarella, F, Galluzzo, L, Salvioli, G, Senin, U, Carbonin, Pu, Bernabei, R, Cherubini, A, Laguzzi, E, Cucinotta, D, Arnone, G, Rozzini, R, Cassinadri, A, Putzu, P, Porceddu, C, Zaru, C, Abate, G, Di Iorio, A, Abate, M, Guglielmi, M, Foschini, N, Battaglini, C, Fellin, R, Volpato, S, Cavalieri, M, Fotini, S, Guerra, G, Rossi, L, Masotti, G, Fumagalli, S, Odetti, P, Cataldi, A, Monacelli, F, Nicita Mauro, V, Basile, G, Maltese, G, Nicita Mauro, C, Pellicciotti, F, Scotto, R, Vaccina, A, Minnucci, A, Forte, L, Lo Storoto, Mr, Licata, G, Tuttolomondo, A, Barbagallo, M, Dominguez, Lj, De Leo, M, Belvedere, M, Putignano, E, Longo, A, Mancioli, G, Patacchini, F, Palmari, N, Ierardi, Ba, Marino, P, Soldato, M, Pilotto, A, Paris, F, Forconi, S, Guerrini, M, De Paduanis, Ga, De Palma, A, Boschi, S, Molaschi, M, Poli, L, Toigo, Gabriele, De Colle, P, Bonoldi, G, Puricelli, S, Pellegrini, R, Consolaro, E, Bosello, O, Zivelonghi, A, Gravic, G, Guariento, S, Di Francesco, V, Tua, E, Pisaturo, A, Lacava, R, Gareri, P, Borgia, R, Cristiano, Vn, Palummeri, Pescetelli, Galdi, M, Bochicchio, Gb, Solimano, A, Brugaletta, S, Carnazza, L, Gallitto, E, Albano, G, Schipani, G, Conte, Pagella, A, Perrero, L, Sabato, V, Marella, L, Schiavina, Zacco, B, Scaglia, L, Virgilio, A, Iera, M, Doria, Pansini, L, Boni, N, Inzitari, M, Aramini, I, Musante, S, Cavagnaro, P, Riello, F, De Alfieri, W, Pescetelli, P, Trecca, R, Di, Iusto, Zamboni, V, Cuppone, R, Foschi, Marino, S, Simone, M, Scarlata, A, Battegazzore, C, Morucci, R, Luchetti, M, Menculini, G, Cichetti, G, Orlando, I, Fantoni, B, Ognibene, G, Gobbi, C, Cascone, A, Avanzi, Gl, Casu, A, Zeni, S, Santin, S, Scotti, G, Cappella, C, and Penzo, P.

Subjects
computerized network, Health care, service, elderly
Abstract

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.

Published
2010

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