Therapeutic concepts for patients with concomitant coronary heart desease and carotid stenosis

Coronary heart disease and high grade carotid stenosis, both requiring operative therapy, commonly occur together. The optimal strategy for affected patients remains controversial, mainly due to a lack of prospective randomised studies. Reported series present inconsistent results, mainly due to a wide variability in indication and patient selection criteria. This review is mostly based on the results of several meta-analyses that have been published recently. The influence of a carotid stenosis on perioperative cerebral risk is often over estimated. Management decisions have to be made individually and depend on the relative severity of the coronary heart or carotid disease.