Simultaneous Treatment of Carotid and Coronary Artery Disease: Current Concept and Results over the past 5 Years

With the introduction of carotid artery stenting (1,2), especially in the so-called high-risk patient, presenting combined carotid artery stenosis (CAS) and coronary artery disease (CAD), a new debate inflamed, and surgical practice was the one that could change something in the near future. It is already recommended to perform first CAS stenting in that high-risk population, followed by a surgery-free period of up to 6 weeks in order to avoid acute stent thrombosis (reported when surgery is performed soon after CAS stenting) (3,4). In regard to that issue, combined coronary and carotid surgery offers the advantage to correct both diseases simultaneously, protecting patients against complications that can occur due to the coexisting untreated carotid or coronary subsystem. Since its introduction in the seventies by Bernhard (5), the combined surgical approach to coronary and carotid arteries has predominantly shown beneficial results. Nowadays, older patients or patients with more progressive diseases are treated. Have we failed to recognize an increased risk during the recent years? To answer that question, we have decided to analyze our experience in the simultaneous surgical treatment of CAS and CAD over the past five years.