Management of patients with concomitant coronary and carotid vascular disease.

Stroke is a major complication of coronary artery bypass graft (CABG) surgery. Carotid stenosis is an important cause of stroke in certain CABG patients. Randomized trials have revealed that carotid endarterectomy (CEA) is clearly indicated in non-CABG patients with symptomatic severe carotid stenosis. CEA is also indicated in patients with symptomatic moderate stenosis and asymptomatic severe stenosis if the predicted incidence of perioperative morbidity and mortality is low. Therapeutic options for patients with concomitant coronary and carotid disease include CABG alone, CABG plus CEA, and CABG plus carotid stenting. In this article we discuss each of these management techniques in detail, and make recommendations regarding the preferred approach in specific patient populations. Copyright 2001 by W.B. Saunders Company