Approach to concurrent coronary and carotid artery disease: Epidemiology, screening and treatment

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) and carotid artery disease (CeAD) often coexist.
• Despite advances, perioperative complication risks remain high for patients with concomitant CAD and CeAD.
• Current literature offers limited guidance on optimal management strategies.

Purpose of the Study:

• To review existing evidence on managing patients with concurrent CAD and CeAD.
• To address the lack of consensus on the optimal initial therapeutic approach (myocardial vs. carotid revascularization).
• To discuss the best surgical techniques, including extracorporeal circulation, hybrid treatments, and other options.

Main Methods:

• Systematic review of published literature.
• Analysis of evidence regarding perioperative outcomes.
• Identification of therapeutic decision-making challenges.

Main Results:

• Limited evidence exists for managing concomitant CAD and CeAD.
• Significant disagreement persists regarding the preferred initial revascularization strategy.
• Optimal surgical techniques and perioperative risk mitigation strategies require further investigation.

Conclusions:

• Managing patients with concomitant CAD and CeAD presents significant challenges.
• Further research is needed to establish evidence-based guidelines for treatment sequencing and technique selection.
• Pragmatic questions are raised to aid clinicians in therapeutic decision-making for this high-risk population.