Abstract
Objective: Peri-procedural hemodynamic depression with carotid artery stenting (CAS) may cause adverse cardiac events in patients with concomitant severe heart disease. Intra-aortic balloon counterpulsation (IABP) increases diastolic pressure, coronary arterial flow and decreases systolic pressure, resulting in the reduction of the left ventricular afterload. We report our experiences in performing CAS with IABP in two patients with concomitant carotid artery severe stenosis and severe heart disease to prevent adverse cardiac events due to hemodynamic depression during and after CAS.
Case report: (Case 1) An 82-year old woman, who had symptomatic right carotid artery severe stenosis and severe aortic valve stenosis (AS), suffering from congestive heart failure and transient ischemic attack. Because hypotension and bradycardia with CAS might be fetal for severe AS, CAS combined with IABP was performed. We successfully placed stents without cardiac or cerebrovascular events occurring. Four weeks after CAS, the patient underwent aortic valve replacement with a blood pump and oxygenator. The postoperative course was uneventful and the patient was discharged. (Case 2) A 71-year old man, having symptoms of angina pectoris, was diagnosed with three-vessel coronary artery disease (CAD) with asymptomatic left carotid artery severe stenosis. CAS with IABP was performed before the coronary artery bypass grafting (CABG), which might need extracorporeal circulation. There were no cardiac or cerebrovascular procedural events observed. Six weeks after CAS, the patient underwent CABG successfully and was discharged.
Conclusion: We conclude that CAS with IABP is an effective method for the treatment of carotid artery stenosis with concomitant severe heart disease, such as severe AS or three-vessel CAD.
