Key result
Staged PCI followed by carotid endarterectomy yields complete neurological recovery with 0% restenosis at 13 months.
Why the study?
Systemic atherosclerosis frequently affects multiple vascular territories simultaneously, and managing patients with concurrent severe carotid and coronary artery disease remains a clinical challenge.
Case Report (n=1)
No
A staged management strategy of percutaneous coronary intervention followed by carotid endarterectomy was safe and effective in a 76-year-old patient with concurrent severe carotid subocclusion and multivessel coronary artery disease following an ischemic stroke.
Answers are grounded in this paper and cite their sources.
Staged PCI-CEA may be feasible in select elderly stroke patients with multivessel disease; leaves open need for prospective trials before wider adoption.
Introduction: Systemic atherosclerosis frequently affects multiple vascular territories simultaneously—cerebral, coronary, and peripheral. Managing patients with concurrent severe carotid and coronary artery disease remains a clinical challenge. Case presentation: We report a female patient (born August 1949), a long-term smoker with hypertension and type 2 diabetes mellitus, who suffered an ischaemic stroke in February 2025 at the age of 75. MSCT angiography revealed subocclusion of the right internal carotid artery (ICA) (>95%) and stenosis of the left ICA (45%). Echocardiography demonstrated moderate aortic regurgitation and left ventricular hypertrophy. Coronary angiography confirmed multivessel coronary artery disease, including a critical 80% right coronary artery (RCA) stenosis, successfully stented in May 2025. Carotid endarterectomy (CEA) of the right ICA was performed in September 2025 at age 76. She was the oldest patient to undergo carotid endarterectomy at the Department of Vascular Surgery, Cantonal Hospital Zenica. Follow-up Doppler ultrasound in November 2025 showed no stenosis in the operated right ICA, stable left ICA stenosis at 55%, and complete neurological recovery. Additional follow-up: In August 2026, repeat echocardiography demonstrated unchanged findings (moderate aortic regurgitation, left ventricular hypertrophy, grade I diastolic dysfunction). In October 2026, colour Doppler of the carotid arteries confirmed stable status—right ICA patent without stenosis, left ICA unchanged at approximately 55%. Conclusion: A staged approach—percutaneous coronary intervention (PCI) followed by CEA—proved safe and effective in this elderly patient with systemic atherosclerosis. Long-term follow-up (to October 2026) confirmed durable carotid patency, stable cardiovascular status, and absence of recurrent cerebrovascular events.
No takes yet. Share an insight, caveat, or question.
Leto et al. (2026) conducted a case report in Severe carotid subocclusion (>95%) and multivessel coronary artery disease following acute ischemic stroke (n=1). Staged percutaneous coronary intervention (drug-eluting stent in the right coronary artery) followed by right carotid endarterectomy was evaluated on Right internal carotid artery patency without restenosis and freedom from recurrent cerebrovascular events. Staged PCI of an 80% RCA stenosis followed by carotid endarterectomy of a >95% right ICA subocclusion achieved complete neurological recovery and 0% restenosis at 13 months post-CEA.
Synapse has enriched 10 related papers. Consider them for comparative context: