RATIONAL APPROACH TO COMBINED CAROTID AND ISCHEMIC-HEART-DISEASE

Background The management of patients with concomitant coronary and ca rotid artery disease remains a controversial subject. The aim of this review was to develop a rational plan for the management of such patie nts based on a review of the literature. Method and results A retrospe ctive review was carried out of relevant papers derived from the Medli ne database from 1964 to 1996. Conclusion The management of patients w ith concomitant coronary and carotid artery disease has not yet been p ut to the test in a properly designed and randomized multicentre trial . It is suggested that, until the results of such a trial are availabl e, the rational approach to combined symptomatic disease is combined c arotid endarterectomy and coronary artery bypass grafting (CABG). Comb ined surgery is also appropriate for patients with symptomatic carotid artery disease and significant but asymptomatic cardiac disease. At p resent there is inadequate evidence to promote carotid endarterectomy for asymptomatic disease in combination with CABG.