Education And Debate

A Difficult Case: Treat the most unstable vascular distribution identified by carotid and cardiac angiography

BMJ 1995; 310 doi: (Published 03 June 1995) Cite this as: BMJ 1995;310:1450
  1. E Magnus Ohman, assistant professor of medicinea
  1. a Duke University Medical Center, Box 3151, Durham, North Carolina 27710, USA

    Randomised clinical trials have helped to define the best approach to patients with isolated unstable angina and multivessel coronary artery disease or symptomatic carotid artery disease. However, the benefit to risk ratio of carotid endarterectomy, coronary artery bypass grafting, or a combined procedure in patients with combined symptomatic carotid and coronary artery disease can be assessed based only on retrospective clinical observations with their inherent limitations. In this case it may therefore be appropriate initially to approach management as if the stroke and unstable angina had occurred in isolation. After the prognosis and need for revascularisation have been clarified for both conditions independently the priority of management and procedures will be simplified.

    The patient has symptoms and signs of intermittent transient ischaemic attack …

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