LONG-TERM RESULTS OF SIMULTANEOUS CAROTID ENDARTERECTOMY AND CORONARY-ARTERY REVASCULARIZATION IN PATIENTS WITH UNSTABLE ANGINA AND CEREBROVASCULAR INSUFFICIENCY

This study assessed the outcome of 11 consecutive high-risk patients ( 8 men, 3 women) with symptomatic, high-grade (greater than 70%) bilate ral carotid stenosis and left main or triple-vessel disease with unsta ble angina undergoing emergency simultaneous carotid endarterectomy (C EA) and coronary artery bypass grafting (CABG) revascularization. Seve n patients presented with crescendo unstable angina and 4 had type III postinfarction unstable angina. All were symptomatic for cerebrovascu lar insufficiency. Six patients had left main and 5 patients had tripl e-vessel disease aside from bilateral carotid lesions. There were 8 me n and 3 women, (mean age 69.1 +/- 3.9 years). The mean preoperative en d-diastolic pressure and ejection fraction were 17.2 +/- 2.4 mm Hg and 35.3 +/- 6.9%, respectively. Sequential reconstruction of the carotid artery was followed by CABG with an average number of 3.1 +/-0.3 graf ts per patient. One patient had additional aortic valve replacement an d 1 had an automatic implantable cardioverter defibrillator implanted. There was no operative mortality. The overall neurologic complication rate was 27.3% (3 of 11). One patient developed perioperative myocard ial infarction and 1 other had respiratory failure. Mean postoperative hospital stay was 24.4 +/- 4.8 days. Within one year postoperation, 1 patient died. Two patients had contralateral CEA owing to recurrent t ransient ischemic attack. The five-year probability of survival was 89 %. Our data show that simultaneous CEA/CABG in patients with high-risk coronary and cerebrovascular insufficiency may result in low mortalit y; however, a relatively increased incidence of short- and long-term m orbidity is expected.