Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
Heart. 2011 Feb;97(3):175-80. doi: 10.1136/hrt.2010.203612. Epub 2010 Dec 13.
The best approach to the management of concomitant severe carotid and coronary artery disease remains unanswered. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend carotid endarterectomy (CEA) in asymptomatic carotid stenosis of ≥ 80% either prior to or combined with coronary artery bypass surgery (CABG). Currently, there is no consensus as to which surgical approach is superior. More recently, carotid artery stenting (CAS) prior to CABG is emerging as an alternative option with promising results in asymptomatic patients considered 'high risk' for CEA. A <3% composite event rate has been set as a benchmark for isolated CAS or CEA in asymptomatic patients by the ACC/AHA; however, most CEA or CAS studies in patients requiring concomitant CABG have shown event rates ranging from 10-12%. This review examines the available data on carotid revascularisation in relation to CABG surgery to aid in the risk-benefit decision analysis in this controversial area.
同时患有严重颈动脉和冠状动脉疾病的管理方法仍未得到解答。美国心脏病学会/美国心脏协会（ACC/AHA）指南建议，在无症状颈动脉狭窄≥80%的情况下，要么在进行冠状动脉旁路移植术（CABG）之前，要么与 CABG 联合进行颈动脉内膜切除术（CEA）。目前，对于哪种手术方法更优，尚无共识。最近，在 CABG 之前进行颈动脉支架置入术（CAS）作为一种替代方案，在被认为 CEA“高危”的无症状患者中取得了有前景的结果。ACC/AHA 将无症状患者中单纯 CAS 或 CEA 的<3%复合事件发生率设定为基准；然而，大多数需要同时进行 CABG 的 CEA 或 CAS 研究显示，事件发生率在 10-12%之间。本综述检查了与 CABG 手术相关的颈动脉血运重建的现有数据，以帮助在这一有争议的领域进行风险效益分析决策。
