COMBINED CAROTID ENDARTERECTOMY AND MYOCARDIAL REVASCULARIZATION - PERSONAL-EXPERIENCE

A significant percentage of patients undergoing myocardial revasculari zation suffer from extracranial cerebrovascular disease; recognition o f such combined lesions identifies patients at risk for cerebrovascula r accidents during the cardiac procedure. Simultaneous or staged coron ary artery bypass graft (CABG) and carotid endarterectomy operations h ave been performed for the last 20 years, however, the clinical indica tions and the timing of the procedures remain controversial issues. Be tween November 1988 and January 1994, 1122 patients underwent myocardi al revascularization at our Institute and in 35 cases (3.7%) carotid e ndarterectomy was simultaneously performed; 502 isolated carotid endar terectomies were performed in the same period. Trivascular coronary ar tery disease was found in 27 cases and low ejection fraction in six. E ach patient received an average of 3.7 coronary grafts. Hospital morta lity was 5.7% and major neurologic morbidity 2.8%. We believe that a s imultaneous approach is recommended in patients with unstable angina a nd symptomatic carotid artery disease; in patients with a critical but asymptomatic carotid artery stenosis the indication for operation is subject to individual clinical judgment.