Treatment of patients with combined coronary and carotid atherosclerosis.
In this article we will review some of the issues surrounding the prevention of neurological and cardiac morbidity in patients with combined coronary and carotid disease and discuss the role of various algorithms of care. Advances in medical care have resulted in a significant prolongation of life. Since atherosclerosis is a disease of aging, the number of patients who come to the attention of cardiac and vascular surgeons has increased and so have their age and co-morbidities. Three decades ago the most common coronary operation was a 1 or 2 vessel bypass in a patient in their 6(th) or early 7(th) decade and the mean age of patients undergoing carotid endarterectomy (CEA) was under 70. Advances in percutaneous coronary techniques and better 8(th) decade and operation on patients over 80 a common occurrence. A similar though less dramatic increase has occurred in the age of patients undergoing CEA. One result of this is that patients often have significant multisite atherosclerosis. Management of these patients has become an increasing concern for cardiac and vascular surgeons. Myocardial ischemia is the principal non-neurological merbidity after CEA as well as the major cause of late death. As cardiac risk after coronary surgery revascularization and its prevention has become an increasing focus for surgeons.
Ricotta
J J
JJ
Division of Vascular Surgery, Stony Brook University, Stony Brook, NY 11794, USA. jricotta@notes.cc.sunysb.edu
Wall
L P
LP
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004691:Endarterectomy; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate