Current perspectives on carotid revascularization among patients who need cardiac surgery

Carotid stenosis is often present in patients who need cardiac surgery and is predictive of post-operative stroke. A strategy of combined carotid endarterectomy and cardiac surgery had been adopted in the past. Staged carotid artery stenting prior to cardiac surgery is a less invasive alternative and seems to be associated with a lower incidence of stroke and myocardial infarction as compared to the combined surgical approach. This article provides a systemic review of the management of patients with concomitant carotid and cardiac disease requiring cardiac surgical procedure, and will discuss some management issues related to carotid stenting in this group of patients. Based on the available data, it is perhaps time to revise our practice guidelines by replacing the combined surgical strategy with the staged carotid stenting and cardiac surgery approach.