The Management of Carotid Artery Stenosis with Coronary Artery Disease

Abstract

We review our experience treating 25 so-called high-risk patients with asymptomatic high-grade carotid stenosis complicated with coronary artery disease. Twelve patients underwent carotid endarterectomy (CEA) for 13 lesions and 14 patients underwent 15 carotid stentings (CAS). The order and choice (CEA vs. CAS; CABG vs. PCI) of carotid and coronary revascularization were decided case by case, considering mainly the degree of therapeutic emergency. Overall, neurological deficits were seen in 0% after CEA and in 25.6% after CAS each, mainly caused by embolic complications. Deterioration of the modified Rankin scale was seen in only 1 CAS case. Mortality was 0% and no major cardiac complications were seen in any group.
The management strategy of combined coronary and asymptomatic carotid stenosis should be decided case by case, considering the degree of systemic atherosclerosis, cardiac conditions, and plaque morphology.