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Treatment strategies in severe symptomatic carotid and coronary artery disease
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 a...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539602/ https://www.ncbi.nlm.nih.gov/pubmed/21804476 http://dx.doi.org/10.12659/MSM.881896 |
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author | Dzierwa, Karolina Pieniazek, Piotr Musialek, Piotr Piątek, Jacek Tekieli, Lukasz Podolec, Piotr Drwiła, Rafał Hlawaty, Marta Trystuła, Mariusz Motyl, Rafał Sadowski, Jerzy |
author_facet | Dzierwa, Karolina Pieniazek, Piotr Musialek, Piotr Piątek, Jacek Tekieli, Lukasz Podolec, Piotr Drwiła, Rafał Hlawaty, Marta Trystuła, Mariusz Motyl, Rafał Sadowski, Jerzy |
author_sort | Dzierwa, Karolina |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3539602 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-35396022013-04-24 Treatment strategies in severe symptomatic carotid and coronary artery disease Dzierwa, Karolina Pieniazek, Piotr Musialek, Piotr Piątek, Jacek Tekieli, Lukasz Podolec, Piotr Drwiła, Rafał Hlawaty, Marta Trystuła, Mariusz Motyl, Rafał Sadowski, Jerzy Med Sci Monit Review Article 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. International Scientific Literature, Inc. 2011-08-01 /pmc/articles/PMC3539602/ /pubmed/21804476 http://dx.doi.org/10.12659/MSM.881896 Text en © Med Sci Monit, 2011 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. |
spellingShingle | Review Article Dzierwa, Karolina Pieniazek, Piotr Musialek, Piotr Piątek, Jacek Tekieli, Lukasz Podolec, Piotr Drwiła, Rafał Hlawaty, Marta Trystuła, Mariusz Motyl, Rafał Sadowski, Jerzy Treatment strategies in severe symptomatic carotid and coronary artery disease |
title | Treatment strategies in severe symptomatic carotid and coronary artery disease |
title_full | Treatment strategies in severe symptomatic carotid and coronary artery disease |
title_fullStr | Treatment strategies in severe symptomatic carotid and coronary artery disease |
title_full_unstemmed | Treatment strategies in severe symptomatic carotid and coronary artery disease |
title_short | Treatment strategies in severe symptomatic carotid and coronary artery disease |
title_sort | treatment strategies in severe symptomatic carotid and coronary artery disease |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539602/ https://www.ncbi.nlm.nih.gov/pubmed/21804476 http://dx.doi.org/10.12659/MSM.881896 |
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