重症心・大動脈疾患を合併した無症候性内頸動脈狭窄症の治療方針と成績(<特集>無症候性内頸動脈狭窄)  [in Japanese] Recent Strategies and Results for Asymptomatic Severe Carotid Artery Stenosis Complicated with Coronary, Valvular, or Aortic Disorder(<Topic>Treatment Strategies for Asymptomatic Carotid Stenosis)  [in Japanese]

We review our recent results in 18 patients with asymptomatic severe (75%<) carotid artery stenosis complicated with coronary, valvular, or aortic disorder that requires surgical treatments. According to our treatment protocol, 4 patients underwent carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) or off-pump CABG (OPCABG) simultaneously. Ten patients underwent 2-staged therapy including CEA or carotid artery stenting (CAS) and cardiovascular surgery. CEA following OPCABG was selected in 2 patients with 75% carotid artery stenosis. Two other complicated patients required 2-staged cardiovascular surgery combined with CEA or 3-staged therapy comprising CAS, CEA, and OPCABG. Overall morbidity and mortality was 11.1% and 5.6%, respectively. Based on our 5-year experiences, we emphasize the importance of thorough multidisciplinary discussion, informed consent, and a skilled team in treating the patients with complicated carotid and coronary artery disorders.