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Rational approach to combined carotid and ischaemic heart disease
S Renton1, P Hornick, K M Taylor
1Department of Vascular, Hammersmith Hospital, London, UK.
Insights
Managing patients with both coronary and carotid artery disease is complex. Combined carotid endarterectomy and coronary artery bypass grafting (CABG) is recommended for symptomatic patients until further trial data is available.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Concomitant coronary and carotid artery disease presents a management challenge.
- Optimal treatment strategies require further investigation.
- Literature review aimed to establish a rational management plan.
Purpose of the Study:
- To review existing literature on managing patients with combined coronary and carotid artery disease.
- To propose a rational management approach based on current evidence.
- To identify areas lacking robust clinical trial data.
Main Methods:
- Retrospective review of medical literature.
- Searched Medline database for relevant studies.
- Data compiled from publications between 1964 and 1996.
Main Results:
- No randomized multicenter trials have definitively addressed this patient population.
- Combined carotid endarterectomy and coronary artery bypass grafting (CABG) is suggested for combined symptomatic disease.
- Evidence does not support routine carotid endarterectomy for asymptomatic disease alongside CABG.
Conclusions:
- Management of combined coronary and carotid artery disease lacks definitive randomized trial evidence.
- Combined carotid endarterectomy and CABG is a rational approach for symptomatic patients.
- Carotid endarterectomy for asymptomatic disease in this context is not currently supported by evidence.
Background:
The management of patients with concomitant coronary and carotid artery disease remains a controversial subject. The aim of this review was to develop a rational plan for the management of such patients based on a review of the literature.
Method And Results:
A retrospective review was carried out of relevant papers derived from the Medline database from 1964 to 1996.
Conclusion:
The management of patients with concomitant coronary and carotid artery disease has not yet been put to the test in a properly designed and randomized multicentre trial. It is suggested that, until the results of such a trial are available, the rational approach to combined symptomatic disease is combined carotid endarterectomy and coronary artery bypass grafting (CABG). Combined surgery is also appropriate for patients with symptomatic carotid artery disease and significant but asymptomatic cardiac disease. At present there is inadequate evidence to promote carotid endarterectomy for asymptomatic disease in combination with CABG.