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Treatment strategies in severe symptomatic carotid and coronary artery disease.

Dzierwa K, Pieniazek P, Musialek P, Piatek J, Tekieli L, Podolec P, Drwiła R, Hlawaty M, Trystuła M, Motyl R, Sadowski J - Med. Sci. Monit. (2011)

Bottom Line: 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%.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland. kdzierwa@gmail.com

ABSTRACT
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.

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Related in: MedlinePlus

Coronary angiogram of the same patient: a critical stenosis of proximal left anterior descending artery (LAD) and stenosis of second marginal branch (Mg). RCA was without significant stenosis after PCI performed 7 years before.
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f4-medscimonit-17-8-ra191: Coronary angiogram of the same patient: a critical stenosis of proximal left anterior descending artery (LAD) and stenosis of second marginal branch (Mg). RCA was without significant stenosis after PCI performed 7 years before.


Treatment strategies in severe symptomatic carotid and coronary artery disease.

Dzierwa K, Pieniazek P, Musialek P, Piatek J, Tekieli L, Podolec P, Drwiła R, Hlawaty M, Trystuła M, Motyl R, Sadowski J - Med. Sci. Monit. (2011)

Coronary angiogram of the same patient: a critical stenosis of proximal left anterior descending artery (LAD) and stenosis of second marginal branch (Mg). RCA was without significant stenosis after PCI performed 7 years before.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539602&req=5

f4-medscimonit-17-8-ra191: Coronary angiogram of the same patient: a critical stenosis of proximal left anterior descending artery (LAD) and stenosis of second marginal branch (Mg). RCA was without significant stenosis after PCI performed 7 years before.
Bottom Line: 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%.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland. kdzierwa@gmail.com

ABSTRACT
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.

Show MeSH
Related in: MedlinePlus