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Review
. 2024 May 21;13(11):3019.
doi: 10.3390/jcm13113019.

Carotid Interventions in Patients Undergoing Coronary Artery Bypass Grafting: A Narrative Review

Andrea Xodo  1 , Alessandro Gregio  1 , Fabio Pilon  1 , Domenico Milite  1 , Tommaso Hinna Danesi  2 , Giovanni Badalamenti  3 , Sandro Lepidi  3 , Mario D'Oria  3
Affiliations
Review

Carotid Interventions in Patients Undergoing Coronary Artery Bypass Grafting: A Narrative Review

Andrea Xodo et al. J Clin Med. .

Abstract

Simultaneous carotid artery stenosis (CS) and coronary artery disease (CAD) is a common condition among patients with several cardiovascular risk factors; however, its optimal management still remains under investigation, such as the assumption that carotid disease is causally related to perioperative stroke and that preventive carotid revascularization decrease the risk of this complication. Synchronous surgical approach to both conditions, performing carotid endarterectomy (CEA) before coronary artery bypass graft (CABG) during the same procedure, should still be considered in selective patients, in order to reduce the risk of perioperative stroke during coronary cardiac surgery. For the same purpose, staged approaches, such as CEA followed by CABG or CABG followed by CEA during the same hospitalization or a few weeks later have been described. Hybrid approach with carotid artery stenting (CAS) and CABG can also be an option in selected cases, offering a minimally invasive procedure to treat CS among patients whom CABG cannot be postponed. When carotid intervention is indicated in patients with concomitant CAD requiring CABG, a personalized and tailored approach is mandatory, especially in asymptomatic patients, in order to define the ideal surgical strategy. The aim of this paper is to summarize the current "state of the art" of the different approaches to carotid artery diseases in patients undergoing CABG.

Keywords: carotid artery stenosis; carotid artery stenting; carotid endarterectomy; coronary artery bypass; coronary artery disease.

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Conflict of interest statement

No conflicts of interest to be declared for this research.

Figures

Figure 1
Figure 1
A 75 female with severe multivessel coronary disease and pre-occlusive stenosis of the right ICA (Panel A), who underwent synchronous CEA with patch angioplasty and CABG (Panel B). (From the Authors’ own collection, reproduced with patients’ permit).
Figure 2
Figure 2
Intraprocedural steps of CEA: Pruitt-Inahara shunt insertion (A,B). Shunt insertion allows the completion of the patch closure in case of a straight ICA (C). (From the Authors’ own collection, reproduced with patients’ permit).
See this image and copyright information in PMC

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