Key result
This review examines available data on carotid endarterectomy and carotid artery stenting in relation to coronary artery bypass surgery, noting event rates of 10-12% in concomitant procedures.
Why the study?
What is the optimal approach for carotid revascularization (CEA or CAS) in relation to CABG surgery in patients with concomitant severe carotid and coronary artery disease?
What is the optimal approach for carotid revascularization (CEA or CAS) in relation to CABG surgery in patients with concomitant severe carotid and coronary artery disease?
Carotid revascularization in patients requiring concomitant CABG carries a high composite event rate (10-12%), highlighting the need for careful risk-benefit decision analysis when managing these complex patients.
High perioperative risk with combined procedures warrants individualized decisions; leaves open optimal carotid revascularization timing and modality with CABG.
The best approach to the management of concomitant severe carotid and coronary artery disease remains unanswered. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend carotid endarterectomy (CEA) in asymptomatic carotid stenosis of ≥ 80% either prior to or combined with coronary artery bypass surgery (CABG). Currently, there is no consensus as to which surgical approach is superior. More recently, carotid artery stenting (CAS) prior to CABG is emerging as an alternative option with promising results in asymptomatic patients considered 'high risk' for CEA. A <3% composite event rate has been set as a benchmark for isolated CAS or CEA in asymptomatic patients by the ACC/AHA; however, most CEA or CAS studies in patients requiring concomitant CABG have shown event rates ranging from 10-12%. This review examines the available data on carotid revascularisation in relation to CABG surgery to aid in the risk-benefit decision analysis in this controversial area.
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Gray et al. (2010) conducted a review in Concomitant severe carotid and coronary artery disease. Carotid revascularisation (CEA or CAS) prior to or combined with CABG was evaluated. This review examines available data on carotid endarterectomy and carotid artery stenting in relation to coronary artery bypass surgery, noting event rates of 10-12% in concomitant procedures.
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