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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Contemporary management of concomitant carotid and coronary artery disease

Sridhar Venkatachalam1, Bruce H Gray, Debabrata Mukherjee

  • 1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.

Heart (British Cardiac Society)
|December 16, 2010
PubMed

Insights

The optimal management for severe carotid and coronary artery disease needing surgery is unclear. This review analyzes carotid revascularization options like carotid endarterectomy (CEA) and carotid artery stenting (CAS) alongside coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Concomitant severe carotid and coronary artery disease management lacks a definitive approach.
  • Guidelines suggest carotid endarterectomy (CEA) for asymptomatic severe carotid stenosis before or during coronary artery bypass surgery (CABG).
  • Carotid artery stenting (CAS) is an emerging alternative for high-risk patients undergoing CABG.

Purpose of the Study:

  • To review current data on carotid revascularization strategies in patients undergoing concurrent CABG.
  • To aid in the risk-benefit analysis for managing combined carotid and coronary artery disease.

Main Methods:

  • Literature review of studies comparing CEA and CAS in patients with concomitant carotid and coronary artery disease.
  • Analysis of event rates and outcomes for different surgical approaches.

Main Results:

  • ACC/AHA guidelines recommend CEA for asymptomatic carotid stenosis ≥ 80% before or with CABG.
  • Established benchmarks for isolated CEA/CAS are <3% event rates.
  • Studies involving CEA or CAS with CABG report higher event rates, typically 10-12%.

Conclusions:

  • No consensus exists on the superior surgical approach for concomitant severe carotid and coronary artery disease.
  • Carotid artery stenting (CAS) shows promise as an alternative for high-risk patients.
  • Further risk-benefit analysis is needed for this controversial clinical scenario.

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