CONCURRENT SURGICAL INTERVENTION FOR TRIPLE-VESSEL CORONARY ARTERY DISEASE, ADVANCED CAROTID ARTERY STENOSIS, AND CAROTID BODY TUMOR: A CASE REPORT AND LITERATURE SYNTHESIS

• Dr. Hiroshi Tanaka

  Department of Cardiology, University of Tokyo Hospital, Tokyo, Japan

  Author

• Dr. Maria Gonzales

  Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA

  Author

The concurrent presentation of triple-vessel coronary artery disease (CAD), severe carotid atherosclerosis, and a carotid body tumor (CBT) is an exceptionally rare and complex clinical scenario, posing significant challenges for diagnosis and management. This case report details the successful single-stage surgical intervention in a 68-year-old male presenting with exertional angina due to severe triple-vessel CAD, transient ischemic attacks from high-grade right internal carotid artery stenosis, and a palpable right neck mass confirmed as a Shamblin Type II carotid body tumor. A multidisciplinary team opted for a combined coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), and carotid body tumor excision to minimize cumulative risks and optimize patient outcomes. The patient tolerated the 7-hour procedure well, with uneventful recovery and complete resolution of symptoms at three-month follow-up. Histopathological examination confirmed a benign carotid body paraganglioma. This report highlights the feasibility and efficacy of a combined surgical approach in carefully selected patients with this unique constellation of pathologies, emphasizing the critical role of meticulous pre-operative assessment and collaborative multidisciplinary planning. A comprehensive literature review is included to discuss diagnostic strategies, surgical considerations, and outcomes associated with these complex coexisting conditions.

1. M. Gooshvar, H. Soleimani, R. Nazari, et al., “Prehospital Factors Contributing to Delays in the Timely Management of ST-Elevation Myocardial Infarction,” Jundishapur Journal of Health Sciences 16, no. 3 (2024): e148078.

2. B. Stark, C. Johnson, and A. R. Gregory, “Global Prevalence of Coronary Artery Disease: An Update From the Global Burden of Disease Study,” Journal of the American College of Cardiology 83, no. 13S (2024): 2320.

3. P. Ebrahimi, R. Nazari, N. Senobari, S. M. Mousavinezhad, D. J. Ghadimi, and H. Soleimani, “Kounis Syndrome Type I Induced by an Intramuscular Injection of Diclofenac: A Literature Review Based on a Case Report,” Clinical Case Reports 12, no. 7 (2024): e9198.

4. A. Achim, O. Á. Péter, M. Cocoi, et al., “Correlation Between Coronary Artery Disease With Other Arterial Systems: Similar, Albeit Separate, Underlying Pathophysiologic Mechanisms,” Journal of Cardiovascular Development and Disease 10, no. 5 (2023): 210.

5. F. Jashari, P. Ibrahimi, R. Nicoll, G. Bajraktari, P. Wester, and M. Y. Henein, “Coronary and Carotid Atherosclerosis: Similarities and Differences,” Atherosclerosis 227, no. 2 (2013): 193–200.

6. J. Huh, M. J. Wall, Jr., and E. R. Soltero, “Treatment of Combined Coronary and Carotid Artery Disease,” Current Opinion in Cardiology 18, no. 6 (2003): 447–453.

7. N. R. Hertzer, “Coronary Angiography in 506 Patients With Extracranial Cerebrovascular Disease,” Archives of Internal Medicine 145, no. 5 (1985): 849–852.

8. I. Bytyçi, R. Shenouda, P. Wester, and M. Y. Henein, “Carotid Atherosclerosis in Predicting Coronary Artery Disease,” Arteriosclerosis, Thrombosis, and Vascular Biology 41, no. 4 (2021): e224–e237.

9. C. A. Hinojosa, J. E. Anaya-Ayala, H. Laparra-Escareno, A. Torres-Machorro, R. Lizola, and A. Gamboa-Domínguez, “Concomitant Surgical Treatment of Symptomatic Carotid Artery Disease With a Coexisting Shamblin I Carotid Body Tumor,” Vascular and Endovascular Surgery 51, no. 2 (2017): 103–107.

10. C. Piazza, D. Lancini, M. Tomasoni, et al., “Malignant Carotid Body Tumors: What We Know, What We Do, and What We Need to Achieve. A Systematic Review of the Literature,” Head & Neck 46, no. 3 (2024): 672–687.

11. Y.-H. Wang, J. Yang, H. Zhong, et al., “Prevalence, Characteristics, Evaluation, and Management of Carotid Body Tumors: Systematic Analysis Based on Available Evidence,” Journal of Vascular Surgery 80, no. 2 (2024): 574–585.e4.

12. D. Nimodia, S. V. Kashikar, P. H. Parihar, V. Nagendra, and S. Dudhe, “Carotid Body Tumor Imaging: MRI, Ultrasound, and Elastography With Surgical Management,” Radiology Case Reports 19, no. 12 (2024): 6085–6092.

13. K. Reitz, A. Ramos, G. Speranza, et al., “Non-Functional Carotid Body Tumors in Patients Without Somatic Mutations May Be Considered for Non- Operative Management,” Annals of Vascular Surgery 85 (2022): 57–67.

14. M. Gonzalez-Urquijo, A. Castro-Varela, A. Barrios-Ruiz, et al., “Current Trends in Carotid Body Tumors: Comprehensive Review,” Head & Neck 44, no. 10 (2022): 2316–2332.

15. L. Gao, X. Zhang, Y. Jiang, et al., “Assessment of Carotid Body Tumors by Superb Microvascular Imaging of Feeding Arteries During Preoperative Evaluation,” Frontiers in Surgery 9 (2022): 816768.

16. M. Işık, F. Kılınç, Y. Dereli, et al., “Surgical and Histopathological Results in Carotid Body Tumors,” Thoracic and Cardiovascular Surgeon (2024), https://doi.org/10.1055/a-2331-2585.

17. M. Evans, S. Minc, and M. Almenoff, “Resection of a Hormonally Active Carotid Body Tumor,” Annals of Vascular Surgery—Brief Reports and Innovations 3, no. 2 (2023): 100185.

18. J. G. Maxwell, S. W. Jones, E. Wilson, et al., “Carotid Body Tumor Excisions: Adverse Outcomes of Adding Carotid Endarterectomy,” Journal of the American College of Surgeons 198, no. 1 (2004): 36–41.

19. S. K. Shah, S. Levine, J. O'Leary, and M. Belkin, “Symptomatic Carotid Stenosis and Ipsilateral Carotid Body Tumor,” Vasa 47, no. 5 (2018): 424–426.

20. M. Smeds and D. Jacobs, “Symptomatic Carotid Stenosis in the Setting of Bilateral Disease and Coexisting Carotid Body Tumor: Management With a Carotid Stent and Staged Excision,” Vascular 21, no. 6 (2013): 396–399.

• pdf

All articles published by The Parthenon Frontiers and its associated journals are distributed under the terms of the Creative Commons Attribution (CC BY 4.0) International License unless otherwise stated. 

Authors retain full copyright of their published work. By submitting their manuscript, authors agree to grant The Parthenon Frontiers a non-exclusive license to publish, archive, and distribute the article worldwide. Authors are free to:

• Share their article on personal websites, institutional repositories, or social media platforms.

• Reuse their content in future works, presentations, or educational materials, provided proper citation of the original publication.