Newman D C, Hicks R G
Department of Cardiothoracic Surgery, Prince Henry Hospital, Sydney, Australia.
Ann Thorac Surg. 1988 May;45(5):574-81. doi: 10.1016/s0003-4975(10)64544-4.
This article reviews 41 different reports that describe various means of surgical management of coexistent carotid and coronary artery disease in almost 1,500 patients. Stroke is the major risk for patients undergoing myocardial revascularization in the presence of symptomatic carotid artery disease or an asymptomatic carotid bruit that reflects an ulcerative lesion or stenosis exceeding 75%. However, patients with asymptomatic carotid stenosis should not routinely undergo prophylactic carotid endarterectomy. Myocardial infarction is the major hazard in patients undergoing carotid endarterectomy who have coronary artery disease. This risk is magnified when the disease is silent. A high level of awareness and rigorous screening are essential in all patients suspected of having coexistent disease. Although a protocol for the management of these patients is important, individual assessment is essential.
本文回顾了41份不同的报告，这些报告描述了近1500例患者并存颈动脉和冠状动脉疾病的各种外科治疗方法。对于有症状性颈动脉疾病或无症状性颈动脉杂音（提示溃疡性病变或狭窄超过75%）的患者，中风是进行心肌血运重建时的主要风险。然而，无症状性颈动脉狭窄患者不应常规接受预防性颈动脉内膜切除术。对于患有冠状动脉疾病且接受颈动脉内膜切除术的患者，心肌梗死是主要风险。当疾病无症状时，这种风险会更大。对于所有怀疑患有并存疾病的患者，高度的意识和严格的筛查至关重要。虽然针对这些患者的管理方案很重要，但个体评估必不可少。
