Published Jul 29, 2022

Daniela Behl  


Patients who suffer from atherosclerosis disease frequently experience coronary heart disease in addition to carotid atherosclerotic stenosis as a complication of their condition. It is of the utmost importance to identify a course of treatment that will optimize the benefits for patients who are suffering from both diseases at the same time and need to undergo surgical intervention. In this review, surgical treatments and perspectives on carotid artery stenosis and coronary artery stenosis were discussed in conjunction with one another.



Carotid Artery Stenosis, Coronary Artery Stenosis, Surgeries, Therapeutic Sequence, Outcomes

1. Jordanova SP, Kedev S, Spirova DP, Stojanovska L, Bosevski M. The role of carotid stenosis in a prediction of prognosis of coronary artery disease. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42(1):53-66. DOI: https://doi.org/10.2478/prilozi-2021-0004

2. Bytyçi I, Shenouda R, Wester P, Henein MY. Carotid atherosclerosis in predicting coronary artery disease: A systematic review and meta-analysis. Arterioscler Thromb Vasc Biol 2021; 41(4):e224-e237. DOI: https://doi.org/10.1161/atvbaha.120.315747

3. Weimar C, Bilbilis K, Rekowski J, Holst T, Beyersdorf F, Breuer M, Dahm M, Diegeler A, Kowalski A, Martens S, Mohr FW, Ondrášek J, Reiter B, Roth P, Seipelt R, Siggelkow M, Steinhoff G, Moritz A, Wilhelmi M, Wimmer-Greinecker G, Diener HC, Jakob H, Ose C, Scherag A, Knipp SC; CABACS Trial Investigators. Safety of simultaneous coronary artery bypass grafting and carotid endarterectomy versus isolated coronary artery bypass grafting: A randomized clinical trial. Stroke 2017; 48(10):2769-2775. DOI: https://doi.org/10.1161/strokeaha.117.017570

4. Masabni K, Raza S, Blackstone EH, Gornik HL, Sabik JF III. Does preoperative carotid stenosis screening reduce perioperative stroke in patients undergoing coronary artery bypass grafting? J Thorac Cardiovasc Surg 2015; 149(5):1253-1260. DOI: https://doi.org/10.1016/j.jtcvs.2015.02.003

5. Plestis KA, Kantis G, Haygood K, Earl N, Howell JF. Carotid endarterectomy with homologous vein patch angioplasty: A review of 1006 cases. J Vasc Surg. 1996; 24(1):109-119. DOI: https://doi.org/10.1016/s0741-5214(96)70151-9

6. Adams A, Bojara W, Schunk K. Early diagnosis and treatment of coronary heart disease in symptomatic subjects with advanced vascular atherosclerosis of the carotid artery (type III and IV B findings using ultrasound). Cardiol Res 2017; 8(1):7-12. DOI: https://doi.org/10.14740/cr516w

7. Adhikary D, Ranjan R, Mandal S, Hawlader MDH, Mitra DK, Adhikary AB. Prevalence of carotid artery stenosis in ischaemic heart disease patients in Bangladesh. SAGE Open Med 2019; 7:2050312119830838. DOI: https://doi.org/10.1177/2050312119830838

8. da Rosa MP, Schwendler R, Lopes R, Portal VL. Carotid artery stenosis associated with increased mortality in patients who underwent coronary artery bypass grafting: A single center experience. Open Cardiovasc Med J 2013; 7:76-81. DOI: https://doi.org/10.2174/1874192401307010076

9. den Hartog AG, Halliday AW, Hayter E, Pan H, Kong X, Moll FL, de Borst GJ; Asymptomatic Carotid Surgery Trial Collaborators. Risk of stroke from new carotid artery occlusion in the Asymptomatic Carotid Surgery Trial-1. Stroke 2013; 44(6):1652-1659. DOI: https://doi.org/10.1161/STROKEAHA.111.000348

10. Doig D, Turner EL, Dobson J, Featherstone RL, de Borst GJ, Stansby G, Beard JD, Engelter ST, Richards T, Brown MM; ICSS Investigators. Risk factors for stroke, myocardial infarction, or death following carotid endarterectomy: Results from the International Carotid Stenting Study. Eur J Vasc Endovasc Surg 2015; 50(6):688-694. DOI: https://doi.org/10.1016/j.ejvs.2015.08.006

11. Pathakota SR, Durgaprasad R, Velam V, Ay L, Kasala L. Correlation of coronary artery calcium score and carotid artery intima-media thickness with severity of coronary artery disease. J Cardiovasc Thorac Res 2020; 12(2):78-83. DOI: https://doi.org/10.34172/jcvtr.2020.14

12. Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, Caplan LR, Day A, Goldstone J, Hobson RW 2nd, et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. Stroke 1995; 26(1):188-201. DOI: https://doi.org/10.1161/01.str.26.1.188

13. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis 2018; 10(3):1960-1967. DOI: https://doi.org/10.21037/jtd.2018.02.43

14. Manthey S, Spears J, Goldberg S. Coexisting coronary and carotid artery disease - which technique and in which order? Case report and review of literature. Clin Med Insights Cardiol 2020; 14:1179546820951797. DOI: https://doi.org/10.1177/1179546820951797

15. Wang LJ, Ergul EA, Mohebali J, Goodney PP, Patel VI, Conrad MF, Eagleton MJ, Clouse WD. The effect of combining coronary bypass with carotid endarterectomy in patients with unrevascularized severe coronary disease. J Vasc Surg 2019; 70(3):815-823. DOI: https://doi.org/10.1016/j.jvs.2018.12.026

16. Gaudino M, Benesch C, Bakaeen F, DeAnda A, Fremes SE, Glance L, Messé SR, Pandey A, Rong LQ; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Stroke Council; and Council on Cardiovascular and Stroke Nursing. considerations for reduction of risk of perioperative stroke in adult patients undergoing cardiac and thoracic aortic operations: A scientific statement from the American Heart Association. Circulation 2020; 142(14):e193-e209. DOI: https://doi.org/10.1161/CIR.0000000000000885

17. Khan MS, Islam MY, Ahmed MU, Bawany FI, Khan A, Arshad MH. On pump coronary artery bypass graft surgery versus off pump coronary artery bypass graft surgery: A review. Glob J Health Sci 2014; 6(3):186-193. DOI: https://doi.org/10.5539/gjhs.v6n3p186

18. Feldman DN, Swaminathan RV, Geleris JD, Okin P, Minutello RM, Krishnan U, McCormick DJ, Bergman G, Singh H, Wong SC, Kim LK. Comparison of trends and in-hospital outcomes of concurrent carotid artery revascularization and coronary artery bypass graft surgery: The United States experience 2004 to 2012. JACC Cardiovasc Interv 2017; 10(3):286-298. DOI: https://doi.org/10.1016/j.jcin.2016.11.032

19. Lescan M, Andic M, Bartos O, Schlensak C, Mustafi M. Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: A retrospective study. BMC Cardiovasc Disord 2020; 20(1):303. DOI: https://doi.org/10.1186/s12872-020-01585-z

20. Giannopoulos S, Texakalidis P, Charisis N, Jonnalagadda AK, Chaitidis N, Giannopoulos S, Kaskoutis C, Machinis T, Koullias GJ. Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Stenosis: A Systematic Review and Meta-analysis. Ann Vasc Surg 2020; 62:463-473.e4. DOI: https://doi.org/10.1016/j.avsg.2019.06.018

21. Ogutu P, Werner R, Oertel F, Beyer M. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery? Interact Cardiovasc Thorac Surg 2014; 18(4):511-518. DOI: https://doi.org/10.1093/icvts/ivt525

22. Illuminati G, Missori P, Hostalrich A, Chaufour X, Nardi P, Ricco JB. Retrospective multicenter study on the management of asymptomatic carotid artery stenosis with coexistent unruptured intracerebral aneurysm. J Vasc Surg 2022; 2022:S0741-5214(22)01832-8. DOI: https://doi.org/10.1016/j.jvs.2022.06.097

23. Paraskevas KI, Nduwayo S, Saratzis AN, Naylor AR. Carotid stenting prior to coronary bypass surgery: An updated systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2017; 53(3):309-319. DOI: https://doi.org/10.1016/j.ejvs.2016.12.019

24. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 2016; 134(10):e123-e155. DOI: https://doi.org/10.1161/CIR.0000000000000404. Erratum in: Circulation 2016; 134(10):e192-e194.

25. Cattaneo M. Aspirin and clopidogrel: Efficacy, safety, and the issue of drug resistance. Arterioscler Thromb Vasc Biol 2004; 24(11):1980-1987. DOI: https://doi.org/10.1161/01.ATV.0000145980.39477.a9

26. Müller MD, Lyrer P, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database Syst Rev 2020; 2(2):CD000515. DOI: https://doi.org/10.1002/14651858.CD000515.pub5

27. Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: A review of clinical data, from pathogenesis to treatment. J Thorac Dis 2016; 8(10):E1150-E1162. DOI: https://doi.org/10.21037/jtd.2016.10.93
How to Cite
Behl, D. (2022). Surgical Treatment of Severe Carotid Artery Stenosis in Conjunction with Coronary Artery Stenosis. Science Insights, 41(2), 605–609. https://doi.org/10.15354/si.22.re073