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Carotid Interventions in Patients Undergoing Coronary Artery Bypass Grafting: A Narrative Review

Andrea Xodo1, Alessandro Gregio1, Fabio Pilon1

  • 1Vascular and Endovascular Surgery Division, "San Bortolo" Hospital, AULSS8 Berica, 36100 Vicenza, Italy.

Journal of Clinical Medicine
|June 19, 2024
PubMed

Insights

Managing simultaneous carotid artery stenosis and coronary artery disease requires personalized strategies. This review explores surgical, staged, and hybrid approaches to reduce stroke risk during cardiac surgery.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Simultaneous carotid artery stenosis (CS) and coronary artery disease (CAD) frequently coexist in patients with cardiovascular risk factors.
  • Optimal management strategies for concurrent CS and CAD remain under investigation.
  • The causal link between carotid disease and perioperative stroke, and the benefit of preventive carotid revascularization, are areas of ongoing study.

Purpose of the Study:

  • To review and summarize current approaches for managing carotid artery disease in patients undergoing coronary artery bypass graft (CABG) surgery.
  • To discuss the state-of-the-art in surgical, staged, and hybrid interventions for CS in patients with CAD.
  • To highlight the importance of personalized treatment strategies for these complex patients.

Main Methods:

  • Review of current literature and clinical practices regarding the management of combined CS and CAD.
  • Analysis of synchronous (CEA before CABG), staged (CEA/CABG or CABG/CEA), and hybrid (CAS with CABG) approaches.
  • Evaluation of strategies for reducing perioperative stroke risk in patients undergoing CABG.

Main Results:

  • Synchronous carotid endarterectomy (CEA) and CABG can be considered in select patients to mitigate perioperative stroke risk.
  • Staged procedures (CEA followed by CABG, or vice versa) and hybrid approaches (carotid artery stenting (CAS) with CABG) offer alternative management options.
  • A tailored, individualized approach is crucial, particularly for asymptomatic patients, to determine the optimal surgical strategy.

Conclusions:

  • The management of patients with both CS and CAD requires a personalized approach, considering various surgical and interventional options.
  • The choice between synchronous, staged, or hybrid procedures should be based on individual patient factors and risk assessment.
  • Further research is needed to refine optimal management protocols for this high-risk patient population.

Keywords:
carotid artery stenosiscarotid artery stentingcarotid endarterectomycoronary artery bypasscoronary artery disease

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