Drakopoulou Maria, Oikonomou Georgios, Soulaidopoulos Stergios, Toutouzas Konstantinos, Tousoulis Dimitrios
First Department of Cardiology, Medical School of Athens University, Hippokration Hospital , Athens , Greece.
Expert Rev Cardiovasc Ther. 2019 Aug;17(8):575-583. doi: 10.1080/14779072.2019.1642106. Epub 2019 Jul 25.
: Ideal management of concomitant carotid and coronary artery occlusive disease remains under investigation. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines. With emerging data suggesting favorable outcome of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options. : This review presents current evidence regarding the prevalence of carotid stenosis in patients with coronary artery disease, the common pathophysiologic links with an emphasis on the diverse mechanisms of stroke in the coronary artery bypass grafting (CABG) setting and discusses the contemporary registries and observational studies comparing outcomes of various revascularization strategies in high-risk patients. Authors conducted a literature search in two bibliographic databases including papers published from 1983 until 2018 (PubMed, Scopus). : Symptoms should drive the need to intervene on carotid stenosis in patients undergoing coronary revascularization. Carotid artery stenting has gained significant ground, especially among those individuals considered of high surgical risk. PCI may be considered as an alternative option for the management of severe concurrent coronary disease.
同时存在的颈动脉和冠状动脉闭塞性疾病的理想治疗方法仍在研究中。尽管研究人员主张根据联合或分期手术治疗采用不同治疗策略可能带来的益处,但治疗指南中尚未达成共识。随着新数据表明,在患有严重冠状动脉疾病的患者中,与颈动脉内膜切除术(CEA)相比,颈动脉支架置入术(CAS)有更好的治疗效果,医生必须考虑这些不同的治疗选择。:本综述介绍了有关冠心病患者颈动脉狭窄患病率的现有证据,强调了在冠状动脉旁路移植术(CABG)背景下中风的多种机制的常见病理生理联系,并讨论了比较高危患者各种血运重建策略结果的当代注册研究和观察性研究。作者在两个文献数据库中进行了文献检索,包括1983年至2018年发表的论文(PubMed、Scopus)。:症状应促使对接受冠状动脉血运重建的患者的颈动脉狭窄进行干预。颈动脉支架置入术已取得显著进展,尤其是在那些被认为手术风险高的人群中。对于严重并发冠心病的治疗,可考虑将经皮冠状动脉介入治疗(PCI)作为一种替代选择。