Management of coexistent carotid artery and coronary artery disease

• Published in: Stroke (1970) 1988-11, Vol.19 (11), p.1441-1444
• Main Authors: GRAOR, R. A, HETZER, N. R
• Format: Article
• Language: English
• Subjects: Angiocardiography; Arteriosclerosis - complications; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - surgery; Cerebral Angiography; Cerebrovascular Disorders - etiology; Coronary Artery Bypass - adverse effects; Coronary Disease - complications; Coronary Disease - diagnosis; Coronary Disease - surgery; Electrocardiography; Endarterectomy - adverse effects; Endarterectomy - methods; Exercise Test; Heart - diagnostic imaging; Humans; Medical sciences; Nervous System Diseases - etiology; Postoperative Period; Radionuclide Imaging; Risk Factors
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.19.11.1441

At the present time staged carotid reconstruction several days before elective coronary artery bypass surgery seems to be the safest and most logical approach for patients with neurological symptoms, stable cardiac symptoms, and acceptable coronary anatomy. Combined procedures may well be necessary for those who have active neurological symptoms or bilateral carotid lesions in conjunction with diffuse or unstable coronary artery disease, but the incidence of neurological complications at the time of simultaneous operations could exceed the stroke risk for either carotid endarterectomy or coronary bypass alone. The asymptomatic patient with unilateral carotid stenosis who presents for coronary artery bypass might be best managed by myocardial revascularization followed by medical or surgical management of the carotid disease. In order to obtain optimal long-term results, both coronary disease and associated carotid disease require appropriate evaluation and medical and surgical management.