Concomitant Versus Staged Percutaneous Cervicocerebral Artery Revascularization with Coronary Artery Bypass Grafting.

INTRODUCTION: The optimal strategy and timing for percutaneous cervicocerebral artery revascularization (PCAR) combined with coronary artery bypass grafting (CABG) remain uncertain in patients with severe carotid or vertebral artery stenosis. METHODS: We retrospectively analyzed adults undergoing concomitant or staged PCAR-CABG at Beijing Anzhen Hospital from January 2011 to December 2025. The primary endpoint was perioperative death or stroke. Strategies were compared using Firth penalized logistic regression. In the staged cohort, restricted cubic splines and interval-based analyses assessed the association between interprocedural interval and outcomes. RESULTS: Among 801 patients, 57 (7.1%) underwent concomitant and 744 (92.9%) underwent staged intervention; the median interprocedural interval was 30 days (interquartile range, 9-46). PCAR was performed for severe vertebral stenosis in 221 (27.6%), severe carotid stenosis in 474 (59.2%), and both in 106 (13.2%). Perioperative death or stroke occurred in one patient (1.8%) in the concomitant group and 37 patients (5.0%) in the staged group. Concomitant intervention was not significantly associated with the primary endpoint after adjustment (adjusted odds ratio (OR) 0.43; 95% confidence interval (CI), 0.05-1.76; P = 0.280). Exploratory analyses suggested decreasing risk with longer intervals, although no significant nonlinear association was identified. The 1-7-day staged group had the highest estimated odds relative to the concomitant group (adjusted OR, 4.89; 95% CI, 1.04-48.30; P = 0.044). CONCLUSIONS: Perioperative death or stroke did not differ significantly between concomitant and staged PCAR-CABG. However, the limited number of events precludes conclusions regarding equivalence. Interval-specific findings were exploratory and require confirmation in adequately powered prospective multicenter studies.