The Brain First or the Heart: The Approach to Revascularizing Severe Co‐Existing Carotid and Coronary Artery Disease

Abstract

Combined symptomatic severe cerebralvascular disease and significant obstructive coronary artery disease frequently exist.1,2 For the past few decades, clinicians have debated the various treatment strategies for these high‐risk patients including staged procedures and hybrid revascularization. While some recommend addressing the more unstable vascular territory first, others prefer to intervene on the carotids prior to performing coronary revascularization. Both surgical and percutaneous options have been explored in various clinical settings, but there are no treatment guidelines to date. Given the frequency and magnitude of this problem, we performed an extensive review of the literature in an attempt to add some much needed clarity. An illustrative case and recommendations are provided. Copyright © 2009 Wiley Periodicals, Inc.

Surgical Treatment for Cervical Carotid Artery Stenosis in the Elderly: Importance of Perioperative Management of Ischemic Cardiac Complications

“…Many reports have suggested the significance of ischemic cardiac complications occurring during surgical treatment for cervical carotid stenosis. 11 – 13) In the present series, thorough preoperative cardiovascular screening of all patients and timely treatment of coronary lesions as required prevented the occurrence of perioperative ischemic cardiac complications. The proportion of patients requiring treatment for coronary lesions prior to CEA or CAS was not significantly different between the two age groups (aged ≥ 80 years and aged ≤ 79 years).…”

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.…”