In the absence of
randomized trials, the optimal management of patients who present with
concomitant carotid and
coronary artery disease remains an enduring controversy, with much of the debate revolving around whether staged or synchronous
carotid endarterectomy (CEA) will reduce peri-operative
morbidity and mortality after
cardiac surgery. Although encouraging results have been reported using either strategy, there remains no consensus as to which is preferable. More recently, however,
carotid artery angioplasty with stenting (CAS) has emerged as a potential alternative to CEA. In 'high-risk for CEA' patients, CAS has shown comparable short and long-term outcome rates to CEA. Accordingly, CAS followed by
cardiac surgery could offer a less invasive (and safer) therapeutic option in
cardiac patients. This paper reviews the evidence to date supporting the use of CAS+
CABG, while highlighting potential situations where such a strategy might be harmful. In particular, it will focus on how the need for dual
antiplatelet therapy after CAS can be balanced with avoiding unnecessary
bleeding complications after
cardiac surgery.
