Treatment of combined coronary and carotid artery disease.
OBJECTIVE
The purpose of this review is to evaluate the current indications and results of treatment of combined coronary and carotid disease. Synchronous carotid stenosis in patients with coronary artery disease poses a management challenge in patients with advanced atherosclerosis.


RESULTS
Recent case series continue to demonstrate concomitant coronary and carotid disease with significant carotid stenosis greater than 70% in approximately 8% of patients evaluated for coronary artery bypass grafting. Surgical management options include staged operations addressing the carotid stenosis first, reverse staged operations addressing the coronary disease first, and combined synchronous operations addressing both territories during the same anesthetic. Recent reports demonstrate safety and acceptable risks with each operative approach. Lower trends in stroke rates were noted following staged procedures when compared with combined procedures. However, several metaanalyses showed no significant difference in rates of combined morbidity and mortality for all three strategies. Total morbidity and mortality risks for combined disease tended to be higher than for isolated coronary artery bypass grafting or carotid endarterectomy procedures performed for disease in a single vascular territory.


CONCLUSIONS
Despite a large volume of data present in the literature, the treatment indications and surgical options remain controversial. We currently advocate treatment of symptomatic territory first in favor of staged procedures and reserve combined procedures for patients with critical stenosis or symptoms in both territories.
Division of Cardiothoracic Surgery, Houston Veterans Affairs Medical Center, Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas 77401, USA. joseph.huh@med.va.gov
Joseph
J
Huh
Matthew J
MJ
Wall
Ernesto R
ER
Soltero
D002340:Carotid Artery Diseases / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D017536:Carotid Artery, Common / Q000473:pathology* / Q000601:surgery; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology