Contemporary management of concomitant carotid and coronary artery disease

Venkatachalam, Sridhar; Gray, Bruce H.; Mukherjee, Debabrata; Shishehbor, Mehdi H.

doi:10.1136/hrt.2010.203612

Cited by 45 publications

(28 citation statements)

References 74 publications

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“…Patients may undergo either carotid TWENTY-FOUR HOUR STAGED CEA/OFF-PUMP CABG surgery simultaneously with coronary surgery or staged with 1 procedure days to weeks after the other [5,15]. Performing CEA before CABG has been shown to decrease post-CABG strokes [3]. Complicating matters, there are multiple operative techniques that may be utilized.…”

Section: Commentmentioning

confidence: 98%

“…Synchronous surgery requires prolonged anesthesia, and several studies have suggested higher rates of stroke and mortality as opposed to staged [3,4,6,8]. Staged procedures expose the patient to the increased risk of developing a stroke if they undergo CABG with untreated carotid disease or MI if they undergo CEA with untreated coronary artery disease.…”

mentioning

confidence: 97%

“…Due to common risk factors including smoking, diabetes, hyperlipidemia, and resultant atherosclerosis, patients with coronary artery disease often have significant carotid artery disease and vice versa [1,2]. In patients requiring coronary revascularization, 3% to 17% have concomitant severe carotid disease [2][3][4][5], and up to 50% of CEA patients have significant coronary disease [6]. Dual disease confounds perioperative morbidity, specifically the risk of myocardial infarction (MI) post-CEA and stroke post-CABG [3,7].…”

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confidence: 99%

“…In patients requiring coronary revascularization, 3% to 17% have concomitant severe carotid disease [2][3][4][5], and up to 50% of CEA patients have significant coronary disease [6]. Dual disease confounds perioperative morbidity, specifically the risk of myocardial infarction (MI) post-CEA and stroke post-CABG [3,7].…”

mentioning

confidence: 99%

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Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

Nabagiez¹,

Bowman²,

Shariff³

et al. 2014

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 98%

mentioning

confidence: 97%

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confidence: 99%

mentioning

confidence: 99%

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Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

Nabagiez¹,

Bowman²,

Shariff³

et al. 2014

The Annals of Thoracic Surgery

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“…CAS before CABG is an alternative option with good results in patients who are considered 'high risk' for CEA. 96 Attempts to refine risk prediction in such patients have been the subject of considerable research, a recent carotid ultrasound study reporting that the total plaque area (HR 1.29, 95% CI 1.08 to 1.55), the number of plaques (HR 1.14, 95% CI 1.02 to 1.27) and the number of segments with plaque (HR 1.45, 95% CI 1.09 to 1.93) were all significantly associated with the 5-year risk of cerebrovascular events. 97 …”

Section: Carotid Artery Stenosisdis Stenting Still An Option?mentioning

confidence: 99%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology. PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL TREATMENTPercutaneous coronary intervention (PCI) has guideline recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI). 1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months. A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.

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Contemporary Management of Patients with Concomitant Coronary and Carotid Artery Disease

2017

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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.

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Contemporary management of concomitant carotid and coronary artery disease

Cited by 45 publications

References 74 publications

Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

Twenty-Four Hour Staged Carotid Endarterectomy Followed by Off-Pump Coronary Bypass Grafting for Patients With Concomitant Carotid and Coronary Disease

Almanac 2012: Interventional cardiology

Contemporary Management of Patients with Concomitant Coronary and Carotid Artery Disease

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