| Autor: |
Servito M; Department of Cardiac Surgery, University of Manitoba, Winnipeg, MB R2H 2A6, Canada., Gill I; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 2V7, Canada., Durbin J; Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON K7L 2V7, Canada., Ghasemlou N; Department of Anaesthesiology, Queen's University, Kingston, ON K7L 2V7, Canada., Popov AF; Department of Cardiothoracic Surgery, Helios Clinic, 53721 Siegburg, Germany., Stephen CD; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., El-Diasty M; Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, ON K7L 2V7, Canada. |
| Abstrakt: |
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients. |
