The brain first or the heart: the approach to revascularizing severe co-existing carotid and coronary artery disease.
Combined symptomatic severe cerebralvascular disease and significant obstructive coronary artery disease frequently exist. For the past few decades, clinicians have debated the various treatment strategies for these high-risk patients including staged procedures and hybrid revascularization. While some recommend addressing the more unstable vascular territory first, others prefer to intervene on the carotids prior to performing coronary revascularization. Both surgical and percutaneous options have been explored in various clinical settings, but there are no treatment guidelines to date. Given the frequency and magnitude of this problem, we performed an extensive review of the literature in an attempt to add some much needed clarity. An illustrative case and recommendations are provided.
Aqel
Raed
R
Division of Cardiovascular Disease, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama 35233, USA. RaedAqel@med.va.gov
Dorfman
Todd A
TA
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
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