Personalized choice of optimal strategy in surgical treatment of patients with combined coronary artery disease and brachiocephalic artery disease

This single-center prospective study included 391 patients with hemodynamically significant coronary artery and internal carotid artery (ICA) stenoses. All patients were divided into four groups depending on the revascularization strategy: group 1 underwent staged surgery: coronary bypass grafting (CABG) followed by carotid endarterectomy (CE) (CABG-CE, n=151, 38.6%); group 2 underwent simultaneous surgery of CABG and CE (CABG+CE, n=141, 36%); group 3 underwent hybrid revascularization: percutaneous coronary intervention (PCI) and CE (PCI-CE, n=28, 7.2%); and group 4 received staged surgery: CE followed by CABG (CE-CABG, n=71, 18.2%). Patients with concomitant coronary artery disease and ICA stenoses had high clinical and instrumental concentration of unfavorable factors, associated with poor prognosis and required the implementation of various surgical revascularization strategies. Maximum severity of complications was recorded in patients with CE-CABG or CABG+CE revascularization strategy. Despite this, the results of simultaneous surgery are very promising. Having evaluated the short- and long-term results of distinct surgery strategies, we designed the algorithm for selection of the revascularization strategy.