A critical review of the role of carotid disease and the outcomes of staged and synchronous carotid surgery.
Few subjects are as enduring as the management of patients with combined carotid and cardiac disease. This paper reviews the available evidence supporting and refuting the role of carotid artery disease in the pathophysiology of stroke after coronary artery bypass grafting surgery and analyzes the results of systematic reviews of staged and synchronous carotid reconstruction. The available data suggest that only about 40% of strokes (at most) could be directly attributable to ipsilateral carotid artery disease. The rate of death and stroke following staged or synchronous carotid surgery in all published series was 6% and 9%, respectively. Unfortunately, natural history data are inadequate to determine whether a policy of prophylactic carotid endarterectomy reduces the risk of stroke after cardiac surgery.
Naylor
A R
AR
Department of Surgery, Leicester Royal Infirmary, Leicester, England. arnaylor@hotmail.com
D002340:Carotid Artery Diseases / Q000150:complications* / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D016894:Endarterectomy, Carotid; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control