COMBINED MYOCARDIAL REVASCULARIZATION AND CAROTID ENDARTERECTOMY - OPERATIVE AND LATE RESULTS IN 331 PATIENTS

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  • 1 January 1983
    • journal article
    • research article
    • Vol. 85  (4) , 577-589
Abstract
Simultaneous coronary artery bypass and carotid endarterectomy were performed in 331 patients (mean age 61 yr) at the Cleveland Clinic [USA] from 1973-1981. Of these, 195 (59%) had functional class III-IV angina pectoris, 308 (93%) had multiple-vessel coronary artery disease (CAD), 68 (21%) had over 50% stenosis of the left main coronary artery and 185 (56%) had either segmental or diffuse impairment of left ventricular function. Asymptomatic carotid stenosis was documented in 173 patients (52%), and the remaining 158 had experienced either previous transient cerebral ischemia (38%) or completed strokes (10%). Single aorta-coronary grafts were placed in 59 patients (18%), double grafts in 131 (40%) and 3 or more grafts in 141 (42%). Of the patients, 19 (5.7%) died postoperatively in the hospital. Neurologic deficits occurred in 30 patients (9.0%) and produced permanent functional impairment in 15 (4.5%). Late results were obtained for 312 operative survivors at a mean postoperative interval of 38 mo. Of the patients, 38 (12%) have died, but the 5-yr life-table survival rate of the study group was identical to that of the normal population aged 61 yr. Significant differences in cumulative 5-yr survival rates were identified among diabetic patients (P < 0.025) and among those receiving single rather than double (P < 0.005) or multiple (P < 0.01) coronary grafts. Although 18 patients (5.8%) have had late strokes, only 5 (1.6%) of these strokes have involved the cerebral hemisphere on the same side as combined carotid endarterectomy.