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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):383-94

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with asymptomatic carotid disease?

Naylor A. R., Bell P. R. F.

Department of Vascular Surgery Leicester Royal Infirmary, Leicester, UK


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The man­age­ment of ­patients ­with com­bined carot­id ­and cor­o­nary ­artery dis­ease ­remains con­tro­ver­sial, large­ly ­because of a ­lack of ­high qual­ity nat­u­ral his­to­ry stud­ies in ­patients ­with asymp­to­mat­ic carot­id dis­ease under­go­ing iso­lat­ed cor­o­nary ­artery ­bypass sur­gery. To ­date, prac­tice rang­es ­from nev­er rec­om­mend­ing addi­tion­al inter­ven­tion to a ­more aggres­sive pol­i­cy of pro­phy­lac­tic carot­id endar­te­rec­to­my. For sur­geons in ­the lat­ter ­group, ­the ­only remain­ing ­debate is wheth­er ­CEA ­should be ­staged or syn­chro­nous. This ­paper ­reviews ­the ratio­nales ­and avail­able evi­dence ­for man­ag­ing ­the car­diac ­patient ­with asymp­to­mat­ic carot­id dis­ease ­and is large­ly ­based on ­the find­ings of 2 recent­ly pub­lished system­at­ic re-­views on ­the sub­ject. These ­reviews sug­gest ­that a reap­prai­sal of prac­tice is nec­es­sary ­before ­the indis­crim­i­nate imple­men­ta­tion of carot­id angio­plas­ty fur­ther com­pli­cates inter­pre­ta­tion of ­the ­already ­poor qual­ity ­data avail­able.

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