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(Circulation. 2007;116:2002-2004.)
© 2007 American Heart Association, Inc.

Editorial

Management of Patients With Concomitant Severe Coronary and Carotid Artery Disease

Is There a Perfect Solution?

Marco Roffi, MD

From the Department of Cardiology, University Hospital, Zurich, Switzerland.

Correspondence to Marco Roffi, MD, FESC, FACC, Andreas Gruntzig Cardiovascular, Catheterization Laboratories, Cardiology, University Hospital, Raemistr 100, CH-8091 Zurich, Switzerland. E-mail marco.roffi@usz.ch

Key Words: Editorials • arterial diseases, carotid • coronary disease • revascularization

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Despite limited evidence of the benefit of carotid revascularization before or together with coronary artery bypass grafting (CABG), patients with advanced carotid and coronary disease are frequently treated by a combined or staged carotid/coronary surgical revascularization. In the present issue of Circulation,¹ investigators from Nieuwegein in the Netherlands describe in a large group of patients (n=356) an alternative revascularization approach: carotid artery stenting (CAS) followed by CABG. The rate of death, stroke, or myocardial infarction (MI) from the time of CAS to 30 days after cardiac surgery (6.8%) compares well with previous surgical series^2–21 (Table). The associated neurological complication rates were low both at 30 days (major ipsilateral stroke 1.1%) and at a mean follow-up of 31 months (neurological death 1.1% and major ipsilateral stroke 1.1%). The carotid restenosis rate was negligible. The authors must be commended for the favorable patient outcomes and for the volume of procedures performed (47 per year), which are superior to most, if not all, recent surgical series of combined coronary-carotid revascularization (Table). Additional important aspects of the study were that patients were accepted for CAS by a consensus decision that involved neurologists, surgeons, and interventionists and that neurologists were deeply involved in the care of those patients throughout the hospital stay.

View this table:   Table. Outcomes up to 30 Days for Patients Undergoing CEA and CABG or CAS Followed by CABG

Article p 2036

With respect to the surgical management of concomitant coronary and carotid disease, a systematic review of the studies . . . [Full Text of this Article]

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