Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2003 June;44(3) > The Journal of Cardiovascular Surgery 2003 June;44(3):395-9

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Estratti

THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632


eTOC

 

III. MANAGEMENT OF THE “POLYVASCULAR PATIENT”
1. CONCOMITANT CAROTID AND CORONARY ARTERY DISEASE
B. Myocardial revascularization and concomitant carotid artery disease  THE MULTIFOCAL ATHEROSCLEROTIC PATIENT
DIAGNOSIS AND MANAGEMENT IN 2003


The Journal of Cardiovascular Surgery 2003 June;44(3):395-9

lingua: Inglese

Treatment of concomitant carotid and coronary artery disease. Decision-making regarding surgical options

Brown K. L.

Division of Vascular Surgery Medical College of Wisconsin, Milwaukee, WI, ­USA


PDF  


Myocardial infarc­tion is ­the ­most com­mon ­cause of ear­ly ­and ­late mor­tal­ity ­after carot­id endar­te­rec­to­my (­CEA). Stroke ­after cor­o­nary ­artery ­bypass graft­ing (CABG) is a dev­as­tat­ing ­and dread­ed com­pli­ca­tion. Up to 28% of ­patients pre­sent­ing ­for ­CEA ­have ­severe, recon­struct­ible cor­o­nary ­artery dis­ease, ­and up to 22% of ­patients pre­sent­ing ­for ­CABG ­have ­severe carot­id ­artery dis­ease. The treat­ment ­for ­these ­patients is con­tro­ver­sial, ­and sur­gi­cal deci­sion-mak­ing is dif­fi­cult. The 3 ­options ­for treat­ment ­include ­the ­staged ­approach (­CEA fol­lowed by ­CABG), ­the ­reversed ­staged ­approach (­CABG fol­lowed by ­CEA), ­and ­the com­bined ­approach (­CEA ­and ­CABG dur­ing ­the ­same anes­thet­ic). The ­result of ­each of ­these approach­es var­ies wide­ly, ­and pri­mar­i­ly ­depends on ­patient selec­tion. The com­bined ­approach is ­well accept­ed in ­those ­patients ­with ­severe, symp­to­mat­ic dis­ease in ­both ­the carot­id ­and cor­o­nary ­artery ter­ri­to­ries. These ­patients ­are at sig­nif­i­cant ­risk ­for ­both ­stroke ­and myo­car­dial infarc­tion (MI), ­and ­the com­bined ­approach min­i­miz­es ­these ­risks. In ­those ­patients ­with asymp­to­mat­ic or ­stable dis­ease in ­one of ­the vas­cu­lar ter­ri­to­ries, ­the ­choice of a ­staged or com­bined pro­ce­dure is ­more con­tro­ver­sial ­and ­the out­come ­data is ­less author­i­ta­tive. No ­data con­firms ­the super­ior­ity of ­one ­approach. Until a mul­ti-insti­tu­tion­al, ran­dom­ized ­trial ­can pro­vide fur­ther objec­tive ­data, man­age­ment of ­these ­patients ­should be guid­ed by ­the rel­a­tive sever­ity of ­their carot­id ­and cor­o­nary ­artery dis­ease ­and ­the ­surgeon’s ­own ­results in ­the treat­ment of ­these ­patient pop­u­la­tions.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail