CAS prior to CABG is emerging as a favorable therapeutic option for patients with concurrent critical coronary and carotid artery disease who are at high risk for CEA.
No consensus guides concomitant carotid-coronary disease management; leaves open need for RCTs to define optimal strategy.
The ideal management of concomitant carotid and coronary artery occlusive disease remains elusive. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines among national or international clinical societies. Clinical studies show that coronary artery bypass grafting (CABG) with either staged or synchronous carotid endarterectomy (CEA) is associated with a high procedural stroke or death rate. Recent clinical studies have found carotid artery stenting (CAS) prior to CABG can lead to superior treatment outcomes in asymptomatic patients who are deemed high risk of CEA. With emerging data suggesting favorable outcome of CAS compared to CEA in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options when treating patients with concurrent carotid and coronary disease. This review examines the available clinical data on therapeutic strategies in patients with concomitant carotid and coronary artery disease. A treatment paradigm for considering CAS or CEA as well as CABG and percutaneous coronary intervention is discussed.
No takes yet. Share an insight, caveat, or question.
Poi et al. (2017) studied this question.
Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context: