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Managing patients with symptomatic coronary and carotid artery disease

A Ross Naylor1

  • 1Leicester Royal Infirmary, Leicester, UK. ross.naylor@uhl-tr.nhs.uk

Perspectives in Vascular Surgery and Endovascular Therapy
|September 23, 2010
PubMed

Insights

Management of concurrent carotid and cardiac disease lacks consensus. Current guidelines may not benefit asymptomatic patients, as combined procedures carry a 9% stroke risk, while isolated coronary artery bypass grafting shows a very low stroke risk.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Medicine

Background:

  • Concurrent carotid and cardiac disease management is controversial, lacking guideline consensus and robust natural history data.
  • Systematic reviews indicate a 9% risk of stroke or death from combined coronary artery bypass grafting (CABG) and carotid procedures (endarterectomy or stenting).
  • Most combined procedures are performed on asymptomatic patients, questioning the actual patient benefit.

Purpose of the Study:

  • To critically evaluate the current management strategies for patients with concurrent carotid and cardiac disease.
  • To challenge existing practices by reviewing contemporary evidence on stroke risk in asymptomatic patients undergoing CABG.

Main Methods:

  • Review of systematic reviews on combined CABG with carotid endarterectomy (CEA) or carotid artery stenting (CAS).
  • Analysis of contemporary studies examining stroke risk in asymptomatic patients with severe carotid stenosis undergoing isolated CABG.

Main Results:

  • Combined CABG and CEA/CAS procedures carry a significant procedural risk of stroke or death (approximately 9%).
  • Contemporary data reveal an extremely low stroke risk in neurologically asymptomatic patients with 70-99% unilateral carotid stenosis undergoing isolated CABG.

Conclusions:

  • The findings challenge the current practice of routine combined procedures for asymptomatic patients.
  • A radical review of evidence and guidelines is mandated to optimize patient care and resource allocation in managing concurrent carotid and cardiac disease.

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