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Concomitant Carotid and Coronary Artery Disease Management: A Review of the Literature

Sami Abou-Assi1, Courtney R Hanak1, Ali Khalifeh1

  • 1Department of Vascular Surgery, Cleveland Clinic Foundation, OH.

Annals of Vascular Surgery
|September 29, 2024
PubMed

Insights

Managing patients with both coronary and carotid artery disease requires careful consideration of stroke risk. This review explores revascularization strategies like carotid endarterectomy (CEA) and carotid artery stenting (CAS) to minimize surgical risks.

Area of Science:

  • Cardiovascular Medicine
  • Neurosurgery
  • Vascular Surgery

Background:

  • Patients with coronary artery disease (CAD) often have concurrent carotid artery disease (CAD).
  • Cerebrovascular events, particularly stroke, represent a significant risk following cardiac surgery in this patient population.
  • Optimal management strategies for combined CAD and CAD remain a clinical challenge.

Purpose of the Study:

  • To review current evidence on managing patients with concomitant coronary and carotid artery disease.
  • To evaluate various revascularization techniques and their efficacy in mitigating perioperative stroke risk.
  • To address controversies regarding carotid revascularization in asymptomatic patients undergoing cardiac surgery.

Main Methods:

  • Systematic review of existing literature on combined coronary and carotid artery disease management.
  • Analysis of data comparing different revascularization strategies: carotid endarterectomy (CEA), carotid artery stenting (CAS), staged vs. simultaneous procedures, and hybrid approaches.
  • Evaluation of screening protocols for carotid stenosis in patients undergoing coronary artery bypass grafting (CABG).

Main Results:

  • Risk factor-based screening for carotid stenosis in CABG candidates is as effective as indiscriminate screening.
  • Comparative efficacy data for staged vs. synchronous CEA/CABG, CAS, and hybrid techniques are presented.
  • Current evidence is insufficient to definitively establish the necessity and optimal timing of carotid revascularization in asymptomatic patients.

Conclusions:

  • Careful patient selection and risk stratification are crucial for managing combined coronary and carotid artery disease.
  • Further high-quality randomized controlled trials are needed to define optimal treatment algorithms and timing for carotid revascularization.
  • Minimizing perioperative stroke risk in this high-risk cohort requires tailored therapeutic approaches.

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