STAGED AND COMBINED SURGICAL APPROACH TO SIMULTANEOUS CAROTID AND CORONARY VASCULAR-DISEASE

  • 1 January 1978
    • journal article
    • research article
    • Vol. 84  (6) , 803-811
Abstract
Between 1969 and 1976, 174 patients were treated surgically for simultaneous carotid and coronary atherosclerosis. In 59 patients, carotid endarterectomy was staged a few days to 6 mo. prior to myocardial revascularization. Severe (more than 60% stenosis) coronary atherosclerosis affected 1 vessel in 11 patients (19%), 2 vessels in 20 patients (34%) and 3 vessels in 28 patients (47%). Left ventricular contraction was impaired in 30 patients (51%). Nine patients (15%) had previous neurological symptoms, and 50 patients (85%) had asymptomatic carotid stenosis. One patient (1.5%) had a permanent stroke after carotid endarterectomy. There were no permanent strokes after staged myocardial revascularization, and the early mortality rate was 1.7%. Combined carotid endarterectomy and myocardial revascularization were performed in 115 patients with severe cardiac disease. Coronary atherosclerosis affected 1 vessel in 10 patients (9%), 2 vessels in 39 patients (34%) and 3 vessels in 66 patients (57%). Left ventricular impairment was present in 72 patients (63%). Thirty-five patients (30%) had previous neurological symptoms, and 80 patients (70%) had asymptomatic carotid stenosis. Five patients (4.3%) had permanent strokes after combined revascularization, and 4 of these patients had occlusion or severe stenosis of the contralateral internal carotid artery. The early mortality rate was 4.3%, but no deaths could be attributed to carotid repair. These results suggest that significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible. In the presence of severe cardiac disease, a combined procedure may be performed in face of higher risk of intraoperative stroke.