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):401-5

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 2,179


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):401-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Carotid intervention prior to or during coronary artery bypass grafting. When is it necessary?

Bandyk D. F., Back M. R., Johnson B. L., Shames M. L.

Division of Vascular and Endovascular Surgery University of South Florida College of Medicine, Tampa, FL, USA


PDF  


Management of patients with advanced atherosclerosis involving the extra-cranial carotid and coronary arteries should be individualized based on symptoms and disease severity. A liberal policy to identify high-grade carotid stenosis using duplex ultrasound testing prior to coronary revascularization is recommended. Carotid intervention is efficacious for stroke reduction in patients with severe (>70% diameter reduction), bilateral internal carotid artery disease, especially if testing indicates abnormal cerebral perfusion via the circle of Willis. The morbidity of a combined carotid-coronary revascularization procedure should be less than 5%, but higher stroke and death rates can be expected in urgent cases with recent hemispheric symptoms. Patients with symptomatic >50% internal carotid artery stenosis should be considered for carotid endarterectomy at the time of coronary revascularization. Carotid angioplasty with cerebral protection is also an appropriate option in “high-risk” cardiac patients, especially in vascular centers with expertise and experience in performing this procedure. A policy of carotid endarterectomy prior to coronary bypass grafting is justified only in patients with stable coronary disease, good ejection fraction, and is best-performed using regional anesthesia.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail