title: Management of combined severe carotid and coronary artery disease.
abstract: Patients with severe carotid and coronary disease-especially if they require coronary artery bypass grafting (CABG)-are at high risk of cardiac events and stroke. Carotid revascularization should be considered for patients with symptomatic carotid disease and bilateral severe asymptomatic carotid stenosis. In patients with unilateral asymptomatic carotid stenosis, decision to proceed to revascularization should be based more on a perspective of long-term stroke prevention than of perioperative stroke reduction. Compared with endarterectomy, carotid artery stenting is associated with a lower incidence of periprocedural myocardial infarction, an event linked to long-term mortality. This observation may be particularly relevant for patients with advanced coronary artery disease such as those undergoing CABG. Irrespective of the carotid revascularization strategy, a broad disease management approach based on lifestyle modification and pharmacologic cardiovascular prevention is more likely to affect both the quality and duration of life than revascularization itself.
authors.affiliation: Interventional Cardiology Unit, Division of Cardiology, University Hospital, Geneva, Switzerland. marco.roffi@hcuge.ch
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
mesh_terms: D016893:Carotid Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome