A modern view on revascularisation of brain and myocardium in patients with multifocal atherosclerosis: A review

Abstract

Among cardiovascular diseases, multifocal atherosclerosis has begun occurring more frequently in the recent years; its manifestations such as coronary heart disease and acute cerebrovascular disease are the primary cause of death and disability worldwide. Both open and endovascular methods of surgical revascularisation of the brain and myocardium are presently used for addressing this global epidemic. Therefore, the outcomes and disease course during both the early postoperative and long-term periods in patients with multifocal atherosclerosis depend on the choice of appropriate surgical strategies. However, there is no consensus on the optimal strategies for the combined treatment of lesions in the coronary and cerebral basins. Consequently, there are no clinical recommendations or randomised trials that provide recommendations on the choice of treatment approaches in this cohort of patients. The specific treatment options are based on the personal experience of the clinic and the decision of the multidisciplinary team.Nevertheless, it is certain that carotid endarterectomy remains the gold standard for the treatment of significant stenosis of internal carotid artery, including that with complex anatomical characteristics and severe calcification; carotid endarterectomy is also the most important preventative measure for the acute violation of cerebral circulation. In addition, given the emergence of new coronary stents and the spread of intravascular imaging methods, percutaneous coronary intervention is increasing its evidence base by the year by demonstrating efficacy even in patients with concomitant left coronary artery trunk and multi-vascular coronary bed lesions.The use of carotid endarterectomy in combination with percutaneous coronary intervention in patients with lesions in both vascular basins for achieving hybrid revascularisation is promising although studied minimally.Therefore, in the present review, we aimed to present the current understanding of the methods utilised for revascularisation of the brain and myocardium as well as the hybrid revascularisation approach for the treatment of patients with multifocal atherosclerosis, with consideration given to its advantages and prospects.Received 12 April 2019. Revised 17 December 2019. Accepted 24 December 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.