Management of patients with concomitant coronary and carotid vascular disease.
Stroke is a major complication of coronary artery bypass graft (CABG) surgery. Carotid stenosis is an important cause of stroke in certain CABG patients. Randomized trials have revealed that carotid endarterectomy (CEA) is clearly indicated in non-CABG patients with symptomatic severe carotid stenosis. CEA is also indicated in patients with symptomatic moderate stenosis and asymptomatic severe stenosis if the predicted incidence of perioperative morbidity and mortality is low. Therapeutic options for patients with concomitant coronary and carotid disease include CABG alone, CABG plus CEA, and CABG plus carotid stenting. In this article we discuss each of these management techniques in detail, and make recommendations regarding the preferred approach in specific patient populations.
Borger
M A
MA
Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Fremes
S E
SE
D015906:Angioplasty, Balloon, Coronary; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D010346:Patient Care Management; D011183:Postoperative Complications / Q000209:etiology; D015607:Stents; D020521:Stroke / Q000209:etiology