Treatment strategies and outcomes of carotid artery stenosis with concomitant cardiac disease: a single-center retrospective study from Japan

Objective Management of patients with concomitant carotid artery stenosis (CS) and cardiac disease remains challenging, and evidence regarding treatment priority and sequencing is limited. This study retrospectively reviewed our single-center experience with CS management in patients with concomitant cardiac disease, based on the institutional treatment workflow used in clinical practice. Methods We included 318 consecutive patients with CS who underwent carotid endarterectomy or carotid artery stenting at the Saitama Cardiovascular and Respiratory Center between 2019 and 2024. Patients were classified into a cardiac group, defined as those with a history of or concomitant cardiac disease, and a non-cardiac group. Patient characteristics, carotid lesion profiles, perioperative neurological complications, and 6-month modified Rankin Scale outcomes were compared. Treatment courses were further reviewed in cardiac-group patients who required staged treatment. Results Overall, 106 patients were classified into the cardiac group. Patients in the cardiac group were older and had higher rates of male sex and circumferential calcification. No significant differences were observed between groups in postoperative symptomatic cerebral infarction, intracranial hemorrhage, cerebral hyperperfusion syndrome (CHS), or unfavorable 6-month functional outcomes. However, CHS occurred more frequently in patients with severe aortic stenosis (p = 0.003). Among eight patients requiring staged treatment, three (38%) experienced unfavorable outcomes. Conclusions In this single-center experience, no significant differences were observed in neurological complications or 6-month functional outcomes between CS patients with and without cardiac disease. However, staged treatment and severe aortic stenosis were associated with clinically important adverse events, underscoring the need for individualized treatment sequencing and multidisciplinary perioperative management.