A SURGICAL APPROACH TO COEXISTENT CORONARY AND CAROTID-ARTERY DISEASE

Objective-To assess the early results of combined coronary artery bypa ss graft surgery and carotid endarterectomy. Design-Retrospective and ongoing analysis of patients who underwent combined coronary artery by pass graft surgery and carotid endarterectomy. Setting-Cardiothoracic unit in a London teaching hospital. Patients-From June 1987 to March 1 995, 64 patients were identified. They were patients who were schedule d to have coronary artery bypass graft surgery or required urgent coro nary revascularisation and who were found to have significant coexiste nt carotid disease. (Unilateral carotid stenosis > 70%, bilateral caro tid stenosis > 50%, or unilateral carotid stenosis > 50% with contrala teral occlusion.) Interventions-Both procedures were performed during one anaesthesia: the carotid endarterectomy was performed first withou t cardiopulmonary bypass. After completion of carotid endarterectomy, coronary artery bypass graft surgery was performed. Main outcome measu res-The incidence of stroke, transient ischaemic attack, and myocardia l infarction in the early postoperative period was analysed. Results-M yocardial revascularisation was successful in all 64 patients. There w ere no perioperative infarcts. In three patients (4 . 7%) a new neurol ogical deficit developed postoperatively: two recovered fully before h ospital discharge. Conclusions-Combined coronary artery bypass graft s urgery and carotid endarterectomy were performed safely and with good results.