Arguments in Favor of Simultaneous Surgeries for Combined Stenosing Atherosclerosis of the Coronary and Carotid Arteries (Literature Review)

Background. For more than 30 years, specialists have been actively discussing the most optimal surgical strategy for patients with combined atherosclerosis of the coronary and carotid arteries. There are proponents of both simultaneous and staged operations on the vessels of these territories. The debate also extends to the methods of arterial intervention — invasive and endovascular.

The aim is to review and analyze the approaches of Russian and foreign authors to various methods of surgical treatment of combined coronary and carotid atherosclerosis.

Materials and methods. Sources from the Web of Science, PubMed, Google Scholar, and eLibrary.ru databases published between 2010 and 2025 were analyzed. The search was conducted using the following keywords: “coronary atherosclerosis”, “carotid atherosclerosis”, “coronary artery bypass grafting”, “coronary stenting”, “carotid endarterectomy”, “carotid bypass”, “staged and simultaneous surgeries”.

Results. A total of 143 articles were identified, 30 of which were included in this review. The opinions of specialists regarding the priority of simultaneous surgeries for combined stenosing atherosclerosis of the coronary and carotid arteries were summarized.

Conclusion. The category of patients with combined coronary and carotid atherosclerosis is extremely heterogeneous. This makes it difficult to define a universal treatment strategy, which must be aligned with a thorough preoperative examination, individual patient characteristics, the experience and capabilities of the clinic, and the results of complication risk stratification. The final decision regarding the type of intervention should be made by a multidisciplinary team. During and after the operation, a protocol of perioperative neuromonitoring and hemodynamic control must be followed.

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