DISEASE OF THE LEFT MAIN CORONARY-ARTERY - EARLY SURGICAL RESULTS ANDTHEIR ASSOCIATION WITH CAROTID-ARTERY STENOSIS

Objectives-To review the results of surgical revascularisation for lef t main coronary artery stenosis and the associated vascular pathology that is responsible for cerebrovascular complication. Patients-60 pati ents (45 men, 15 women) (mean age 61.3 (39-79)) who underwent revascul arisation for stenosis of the left main stem coronary artery (LMS) bet ween January 1987 and August 1990 were compared with an age and sex ma tched control group of patients undergoing revascularisation for tripl e vessel disease during the same period. Outcome measures-In-hospital morbidity and operative mortality. Results-24 patients in the LMS grou p presented with unstable angina. The left ventricular ejection fracti on was less than 50% in 30 patients and less than 30% in nine. 17 pati ents (28%) had large vessel extracranial carotid artery disease and 10 patients had vascular disease of the lower limbs. In six patients ath eromatous plaques were noted in the ascending aorta during surgery. Th ere was no in-hospital mortality. In-hospital morbidity included neuro logical deficits in five (8.3%), arrhythmias in seven (11.6%), and pul monary complications in six (10%) patients. The incidence of carotid a rtery disease in the LMS group was significantly higher (p = 0.04). At heromatous plaque in the ascending aorta and postoperative neurologica l complications were more common patients with LMS. Conclusions-The in cidence of carotid artery disease was higher and postoperative cerebro vascular complications were more common in patients who had coronary a rtery revascularisation for stenosis of the left main stem coronary ar tery. The early surgical results were excellent. These findings sugges t that for optimum perioperative management patients with stenosis of the left main coronary artery should be screened for carotid artery di sease before bypass surgery.