Revascularization methods in patients with carotid stenosis and concomitant coronary heart disease

Abstract

A major feature of the atherosclerotic process is its systemic and progressive character. The plaque pathogenetic mechanisms, morphology, evolution, and predilection site (bifurcation zones) determine the frequent coincidence of carotid and coronary atherosclerosis in the same patient. The present overview chronologically traces the history, effectiveness, and benefit of surgical and continuously improving interventional carotid revascularization. It thereby analyzes the indications, results, and complications based on a number of randomized clinical trials, industry-sponsored registries, and large single-center series in the last 3 decades. Carotid endarterectomy (CEA) and percutaneous carotid angioplasty (CAS) have evolved from ‘dubious’ procedures to a modern strategy resulting in a significantly lower incidence of stroke and death compared to medical treatment only. Although almost every second patient with carotid stenosis and indications for CAS has coronary atherosclerosis, studies on therapeutic modeling in such a combination are few, showing controversial results. Having both CHD and CS doubles the risk of myocardial infarction, stroke, HF, and death. An isolated revascularization approach compromises the results of therapeutic strategies and worsens patient survival. The high risk associated with coronary heart disease in CAS and CEA is a fact and minimization requires both an individualized and uniform stepwise revascularization strategy.

A Multidisciplinary Approach in Selecting Treatment Strategies in Patients with Aortic and Peripheral Artery Diseases

“…The 6.1-year survival rate was 95.6 ± 3.2% in group A and 89.7 ± 3.7% in group B. This study proved that selective coronary angiography followed by myocardial revascularization prior to CEA in patients with asymptomatic coronary artery lesions is safe and can improve long-term survival and freedom from MI [19].…”

“…The importance of preoperative diagnosis and revascularization of coronary artery lesions in patients with severe carotid artery lesions was reported by Illuminati et al [19]. The RCT included 426 patients without prior angina and myocardial ischemic changes according to ECG and Echo-CG.…”

“…Critical lower limb ischemia is associated with significant disability and mortality. Since its diagnosis in patients without limb revascularization, amputation is required in 20-40% of patients within 6 months and less than 80% of patients survive [19,39,48]. A large German registry reported that critical lower limb ischemia was associated with the 4-year amputation rate of 35-67% and the related mortality rate of 52-64% [49].…”

Endarterectomía vs injerto endovascular en pacientes con estenosis de la arteria carótida interna

“…Existen varios estudios emblemáticos que han demostrado el beneficio de la CEA en pacientes sintomáticos (26,27). Se ha descubierto que los pacientes que se someten a cirugía y tratamiento farmacológico tienen entre un 9 y un 15% de riesgo de sufrir un accidente cerebrovascular recurrente, que se reduce significativamente en comparación con el riesgo >25% del tratamiento farmacológico solo (28).…”

Serum ANGPTL4 and SIRT1 factor levels and the Carotid Atherosclerotic plaque stability relationship analysis

“…One of the main characteristics of atherosclerosis is its systematic and progressive nature. The pathogenesis, morphology, evolution, and segmental (bifurcation) stability of plaque determine the occurrence and development of complications of carotid and coronary atherosclerosis in patients (3). Research showed that an association was observed between the neovascularization and stability of carotid artery plaques and the progression of coronary artery disease (4).…”