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Management of concomitant severe carotid and coronary artery disease in the current era
  1. Sridhar Venkatachalam1,
  2. Bruce H Gray2,
  3. Debabrata Mukherjee3,
  4. Mehdi H Shishehbor4
  1. 1Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Vascular Surgery, Greenville Hospital System, Greenville, South Carolina, USA
  3. 3Division of Cardiovascular Medicine, Texas Tech University, Paul Foster School of Medicine, El Paso, Texas, USA
  4. 4Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Mehdi H Shishehbor, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J3-5, Cleveland, OH 44195, USA; shishem{at}gmail.com

Abstract

The best approach to the management of concomitant severe carotid and coronary artery disease remains unanswered. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend carotid endarterectomy (CEA) in asymptomatic carotid stenosis of ≥80% either prior to or combined with coronary artery bypass surgery (CABG). Currently, there is no consensus as to which surgical approach is superior. More recently, carotid artery stenting (CAS) prior to CABG is emerging as an alternative option with promising results in asymptomatic patients considered ‘high risk’ for CEA. A <3% composite event rate has been set as a benchmark for isolated CAS or CEA in asymptomatic patients by the ACC/AHA; however, most CEA or CAS studies in patients requiring concomitant CABG have shown event rates ranging from 10–12%. This review examines the available data on carotid revascularisation in relation to CABG surgery to aid in the risk–benefit decision analysis in this controversial area.

  • Severe carotid
  • coronary artery disease
  • peripheral vascular disease
  • atherosclerosis
  • coronary artery disease (CAD)

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Footnotes

  • Competing interests Dr Shishehbor has received honorarium from Abbott Vascular.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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