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Continuing controversy in the management of concomitant coronary and carotid disease: an overview.

Authors
  • Das, S K
  • Brow, T D
  • Pepper, J
Type
Published Article
Journal
International Journal of Cardiology
Publisher
Elsevier
Publication Date
Jun 12, 2000
Volume
74
Issue
1
Pages
47–65
Identifiers
PMID: 10854680
Source
Medline
License
Unknown

Abstract

Stroke at CABG is due to multiple risk factors, one of which is high-grade carotid stenosis. Pathophysiology of stroke, although multifactorial, supports embolism rather than flow limitation as the primary mechanism. Lack of randomised trials has made it impossible to draw firm conclusions regarding the best management strategy. There was no significant difference in the overall stroke and mortality risk between the various strategies, however, subgroup analysis suggests that, when carefully selected, patients do better by staging the operations. In our opinion patients without severe cardiac disease should be considered for Prior staging and the rest for Combined procedure. The role of reverse staging needs further evaluation.

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