Treatment strategies in severe symptomatic carotid and coronary artery disease.
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Registries (usually single-centre) indicate an MAE rate of ≈7% for CAS followed by CABG (frequently after >30 days, due to double antiplatelet therapy).Recently, 1-stage CAS-CABG has been introduced.This involves different antiplatelet regimens and, in some centers, preferred off-pump CABG, with a cumulative MAE of 1.4-4.5%.
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PubMed Central - PubMed
Affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland. kdzierwa@gmail.com
ABSTRACT
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Coexistent carotid artery stenosis (CS) and multivessel coronary artery disease (CAD) is not infrequent. One in 5 patients with multivessel CAD has a severe CS, and CAD incidence reaches 80% in those referred for carotid revascularization. We reviewed treatment strategies for concomitant severe CS and CAD. We performed a literature search (MEDLINE) with terms including carotid artery stenting (CAS), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), stroke, and myocardial infarction (MI). The main therapeutic option for CS-CAD has been (simultaneous or staged) CEA-CABG. This, however, is associated with a high risk of MI (in those with CEA prior to CABG) or stroke (CABG prior to CEA), and the cumulative major adverse event rate (MAE - death, stroke or MI) reaches 10-12%. With increasing adoption of CAS, a sequential strategy of CAS followed by CABG has emerged. Registries (usually single-centre) indicate an MAE rate of ≈7% for CAS followed by CABG (frequently after >30 days, due to double antiplatelet therapy). Recently, 1-stage CAS-CABG has been introduced. This involves different antiplatelet regimens and, in some centers, preferred off-pump CABG, with a cumulative MAE of 1.4-4.5%. No randomized trial comparing different treatment strategies in CS-CAD has been conducted, and thus far reported series are prone to selection/reporting bias. In addition to the established surgical treatment (CEA-CABG, sequential/simultaneous), hybrid revascularization (CAS-CABG) is emerging as a viable therapeutic option. Larger, preferably multi-centre, studies are required before this can become widely applied. Related in: MedlinePlus |
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f1-medscimonit-17-8-ra191: An example of the patient with critical RICA stenosis before and after successful CAS procedure in a patient after left hemisphere stroke (occluded LICA) accepted for staged CAS – CABG strategy. Mentions: Two possible hybrid revascularization strategies are staged CAS-CABG (1st stage CAS and then CABG in at least 5 weeks, Figures 1, 2), and simultaneous 1-stage CAS-CABG (CAS and then CABG on the same day, Figures 3–6). |
View Article: PubMed Central - PubMed
Affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland. kdzierwa@gmail.com