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Introduction: Patients who have simultaneous carotid and coronary artery atherosclerotic disease represent a high-risk group for whom the treatment strategy is not clearly defined. Our article aims to compare the benefits and disadvantages of simultaneous CEA/CABG, staged CEA and reverse-staged CEA procedures. Methods: Review of literature—two prospective randomized trials and many retrospective studies together with personal experience were included. Many studies comparing the three surgical strategies were performed. Results: No firm evidence-based data are available so far. Many studies advocate simultaneous procedures based on low morbidity/mortality. Other papers show no difference between simultaneous and staged CEA surgeries. There is an agreement that reverse-staged CEA brings a high risk of stroke. In our department, simultaneous CEA/CABG is performed in cardiac instability and either (1) symptomatic ≥50% ICA stenosis, (2) bilateral asymptomatic ICA stenosis ≥70%, (3) asymptomatic ICA stenosis ≥70% and contralateral carotid occlusion. Conclusions and recommendation (SVS and ESVS guidelines):

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Management of Simultaneous Coronary Bypass and Carotid Surgery

  • 章节

  • 发表日期：

    2026年

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  • Vladimir Priban,
  • Jiri Dostal,
  • Jan Mracek

摘要

Introduction: Patients who have simultaneous carotid and coronary artery atherosclerotic disease represent a high-risk group for whom the treatment strategy is not clearly defined. Our article aims to compare the benefits and disadvantages of simultaneous CEA/CABG, staged CEA and reverse-staged CEA procedures. Methods: Review of literature—two prospective randomized trials and many retrospective studies together with personal experience were included. Many studies comparing the three surgical strategies were performed. Results: No firm evidence-based data are available so far. Many studies advocate simultaneous procedures based on low morbidity/mortality. Other papers show no difference between simultaneous and staged CEA surgeries. There is an agreement that reverse-staged CEA brings a high risk of stroke. In our department, simultaneous CEA/CABG is performed in cardiac instability and either (1) symptomatic ≥50% ICA stenosis, (2) bilateral asymptomatic ICA stenosis ≥70%, (3) asymptomatic ICA stenosis ≥70% and contralateral carotid occlusion. Conclusions and recommendation (SVS and ESVS guidelines):