SAFETY AND EFFICACY OF CONCOMITANT CAROTID AND CORONARY-ARTERY OPERATIONS

Background. Controversy exists concerning the best management for pati ents with concurrent severe carotid and coronary artery disease. Metho ds. The records of 200 consecutive patients having concurrent carotid endarterectomy and coronary artery bypass grafting from 1979 to 1993 w ere reviewed, and follow-up was obtained (99% complete). Of the group (77% male; mean age, 67 years), 134 (67%) had unstable angina, 130 (65 %) had triple-vessel disease, and 86 (43%) had left main coronary sten osis. Preoperative investigation revealed asymptomatic bruits in 116 ( 58%), transient ischemia in 65 (32%), strokes in 31 (16%), and bilater al carotid disease in 44 patients (22%). Nonelective operations were r equired in 66 patients (33%). Results. Hospital death occurred in 7 pa tients (3.5%), myocardial infarction in 5 (2.5%), and permanent stroke in 6 (3%). Ten-year actuarial event-free rates were as follows: death , 58%; myocardial infarction, 81%; stroke, 92%; percutaneous angioplas ty, 98%; redo coronary artery grafting, 94%; and all morbidity and mor tality, 56%. Significant multivariate predictors of hospital death wer e postoperative stroke, failure to use an internal mammary artery graf t, intraoperative intraaortic balloon, and nonelective operation. Sign ificant predictors of postoperative stroke were peripheral vascular di sease and unstable angina. Significant predictors of prolonged hospita l stay were postoperative stroke, advanced age, and nonelective operat ion. Conclusions. Concomitant carotid endarterectomy and coronary bypa ss grafting can be performed with acceptably low operative risk and go od long-term freedom from coronary and neurologic events.