SIMULTANEOUS CAROTID ENDARTERECTOMY AND CORONARY-BYPASS - PERIOPERATIVE RISK AND LONG-TERM SURVIVAL

Purpose: The purpose of this article is to examine the outcome of simu ltaneous coronary bypass-carotid endarterectomy (CABG-CEA) and to comp are it with the outcome of endarterectomy alone (CEA alone) in patient s at high cardiac risk. Methods: A retrospective review of the records and follow-up data for 100 consecutive patients who had undergone CAB G-CEA and were at high risk and 114 patients who had undergone CEA, ha d overt coronary artery disease (angina, previous infarct, or ischemic electrocardiographic abnormalities), but had not undergone CABG was c arried out. Results: Our CABG-CEA group had a high incidence of sympto matic carotid disease (57%) and contralateral occlusion (28%) when com pared with patients in other reports. Patients in the CABG-CEA group w ere older (67.9 +/- 8.3 years vs 63.6 +/- 15.7 years, p = 0.01) and mo re often smokers (81% vs 52.6%, p = 0.01) than patients in the CEA alo ne group. Perioperative mortality was 8% for the CEA-CABG group and 1. 8% for the CEA alone group (p = 0.035). Perioperative stroke morbidity was 9% for the CEA-CABG group and 2.6% for the CEA alone group (p = 0 .05). Life table survival at 1, 3, and 5 years was 90%, 82%, and 73% v ersus 96%, 84%, and 76% for the CABG-CEA and CEA alone groups, respect ively (p = 0.30). Conclusions: Selection criteria for CABG-CEA greatly influence perioperative risk. Despite the greater age and more advanc ed coronary artery disease in the CABG-CEA group, long-term outcome di fferences are accounted for entirely by differences in perioperative m orbidity and mortality. Prospective trials of strategies such as stage d CEA and CABG to reduce perioperative risk are needed.