MANAGEMENT OF COEXISTENT CAROTID AND CORONARY-ARTERY DISEASE

Simultaneous coronary artery bypass grafting (CABG) and carotid endart erectomy (CE) were done on 133 patients over an 8-year period. Twenty- seven patients (20%) had previous transient ischemic attacks (TIAs), 1 2 (9%) had previous strokes, and the remainder (71%) were asymptomatic . All asymptomatic patients had greater than 85% stenosis of the inter nal carotid artery demonstrated by noninvasive ultrasonography and fou r-vessel angiography. CE was performed prior to the sternotomy for cor onary artery bypass, under the same anesthesia. Nineteen patients had bilateral carotid artery disease. Postoperatively, three patients (2.3 %) suffered strokes, an additional three patients (2.3%) suffered tran sient upper extremity weakness, and one patient from each of these gro ups died. There were no postoperative strokes or TIAs in patients with bilateral carotid artery disease. Average length of hospital stay was 10 days. Our experience leads us to conclude that the morbidity and m ortality of the simultaneous procedure are not affected by bilateral c arotid artery disease. In patients with symptomatic coronary artery di sease and symptomatic carotid artery disease or asymptomatic carotid a rtery disease with a high-grade stenosis, we think that simultaneous r epair of both lesions should be done.