Simultaneous Carotid and Coronary Arteries Disease: Staged or Combined Surgical Approach?

Abstract

Despite the highly selected populations, the contemporary surgical results indicate that the management of these patients needs careful pre-, intra-, and postoperative assessment and timing aimed at reducing the ischemic injuries, both cerebral and cardiac, therefore we believe that the surgical technique should be individualized for each patient.

Combined Carotid and Cardiac Surgery: Improving the Results

“…Proposed therapeutic strategies have included simultaneous CEA-CABG, staged or reverse staged procedures, performing only CABG, carotid artery stenting (CAS) before CABG, and the use of off-pump CABG. [8][9][10] However, despite multiple studies, there remain no generally accepted guidelines for the optimal therapeutic approach to adopt in this subgroup of patients.…”

Cerebral revascularization in patients older than 70 years

“…Поэтому в указанной кагорте лиц возникает необходимость тща-тельного системного обследования, в частности состоя-ния резерва коронарного кровообращения. В случае вы-явления значимого поражения коронарного русла, для профилактики ИМ вставал вопрос о необходимости рева-скуляризации сердца предварительно или одновременно [1,5]. При тяжелой стенокардии мы отправляли больных на предварительное стентирование коронарных артерий или на одномоментную коррекцию двух сосудистых бас-сейнов.…”

Treatment Strategy for Combined Carotid Artery Stenosis and Coronary Artery Disease: Staged or Simultaneous Surgical Procedure?

“…Totally 41,901 patients undergoing simultaneous or staged carotid and coronary procedures were collected from 53 reports (Evagelopoulos et al 2000;Snider et al 2000;Minami et al 2000;Gaudino et al 2001;Hamulu et al 2001;Youssuf et al 2001;Estes et al 2001;Farooq et al 2001;Bonacchi et al 2002;Bonardelli et al 2002;Antunes et al 2002;Zacharias et al 2002;Meharwal et al 2002;Roddy et al 2002;Char et al 2002;Beauford et al 2003;Brown et al 2003;Vitali et al 2003;Ricotta et al 2003;Srimahachota et al 2004;Mishra et al 2004;Ricotta et al 2005;Ziada et al 2005;Cinar et al 2005;Eren et al 2005;Chiappini et al 2005;Akins et al 2005;Nwakanma et al 2006;Inciura and Benetis 2006;Kolh et al 2006;Byrne et al 2006;Cywinski et al 2006;Kovacic et al 2006;Mendiz et al 2006;Randall et al 2006;Chiariello et al 2006;Hertzer and Mascha 2006;Madi-Jebara et al 2006;Kougias et al 2007;Dubinsky and Lai 2007;…”

“…Meta analysis of relevant literature between 1980 and 1998 revealed a significantly increased risk of stroke or death, for patients undergoing simultaneous procedures (Borger et al 1999). Chiappini et al (2005) described the hospital mortality was 6.4% in simultaneous , and hospital mortality (right lower panel). 1 = simultaneous carotid endarterectomy and coronary artery bypass; 2 = simultaneous carotid endarterectomy and off-pump coronary artery bypass; 3 = simultaneous carotid artery stenting and coronary artery bypass; 4 = staged carotid endarterectomy and coronary artery bypass; and 5 = staged carotid arterial stenting and coronary artery bypass.…”