44 www.medfak.ni.ac.rs/amm Original article UDC: 616.132.2/.133-08 doi:10.5633/amm.2019.0108 A STRATEGY FOR THE TREATMENT OF PATIENTS WITH CORONARY ARTERY DISEASE AND THE PRESENCE OF SIGNIFICANT CAROTID ARTERY STENOSIS: ANALYSIS OF THE "STAGED" AND "CONCOMITANT" APPROACHES Saša S. Živić 1 , Dragan J. Milić 1,2 , Mile Vraneš 3 , Miloš Velinović 3 , Dragan C. Bogdanović 4 Today, there is no unequivocal overview of how to treat patients undergoing myocar- dial revascularization and have associated significant carotid artery stenosis. In this group of patients, there are several ways to treat, and our study analyzed patients who were exposed to a "Staged" and "Concomitant" approach. During 2016 in three cardiac surgery centers of Serbia, the perioperative results of the patients subjected to a "Staged" and "Concomitant" approach were analyzed. Group 1 including patients with cardiac revascularization and endarterectomy was made at least 30 days earlier, and group 2 consisted of patients who underwent endarterectomy with cardiac revasculariza- tion simultaneously. In both groups, CVI appearance was observed 7 days after the revasculari- zation of the heart. We followed the risk factors for the occurrence of CVI. The conducted study included a total of 49 patients, divided into two groups. In 28 patients (group 1) Eversion Carotid endarterectomy was performed 30 days to 26 months prior to coronary revascularization. The average age of patients was 64 and 65 years, with the pre- valence of male sex (86%: 14%). The only parameters that showed a significant difference between the groups were "left main syndrome" and unstable angina pectoris, both in Group 2. In the ensuing period, in both groups, there were no postoperative major neurological events (CVI). In one patient, clinical signs of neurological deficits occurred in the form of weakness of one side of the body, but CVI was not proven by CTom and MRA. It can be concluded that the "Staged" and "Concomitant" approaches are safe and effective. Acta Medica Medianae 2019;58(1):44-49. Key words: myocardial revascularization, carotid artery stenosis, Staged approach, Concomitant approach 1 Clinical center Niš, Cardiovascular and transplant surgery Clinic, Niš, Serbia 2 University of Niš, Faculty of Medicine, Niš, Serbia 3 Clinical center Serbia, Cardiovascular diseases clinic, Belgrade, Serbia 4 Public health Institute Niš, Niš, Serbia Contact: Saša Živić Blvd. Dr Zoran Djindjić 48, 18000 Niš, Serbia E-mail: zivicdr@gmail.com Introduction Cardiovascular disease is the leading cause of morbidity and mortality in the world, responsible for 17.3 million deaths a year and is expected to rise to 23.6 million by 2030.y. About 80% of these deaths occur in low and medium-developed countries (1), which includes our country. Ischemic heart disease, caused predominantly by arteriosclerosis, is the most common form of heart disease. Arteriosclerosis is a diffuse process involving various vascular systems with significant overlap between coronary, cerebro- vascular and peripheral arterial systems (2). This condition is associated with similar predi- sposing risk factors and genetic predisposition. In the population of patients with coronary artery disease, the presence of 11.1-25.4% of cerebrovascular dise- ase was observed (3, 4). One of the main risk fac- tors for the development of arteriosclerotic disease, which equally affects the development of CAD and CVD, is age. All clinical studies show an increasing average age of patients undergoing CABG, so the risk of a significant CVD is increasing. The average age of 56 years old in 1980 jumped to 68 in 2001.y. In 1980, only 6% of patients were older than 70 years old, while according to data from 2001, even 45% were older than 70 and 13% older than 80