CAROTID ENDARTERECTOMY COMBINED WITH MYOC ARDIAL REVASCULARIZATION - REPORT OF 27 PATIENTS

Atheroesclerosis is a systemic disease that may involve more than one territory. Myocardial infarction can occur after carotid endarterectom y and stroke is a well documented morbidity of coronary artery bypass grafting. To optimize results, we have performed concomitant carotid e ndarterectomy and myocardial revascularization in selected cases, with severe disease in both territories. During a 13-year period, 27 patie nts were submitted for this procedure, 21 (77.8%) were male and the av erage age was 67.6 years (range 59-81). All patients had high-grade in ternal carotid artery stenosis, five (18.5%) were symptomatic. Coronar y artery disease symptoms were: unstable angina in 12 patients (44.4%) and effort angina in 15 (55.6%). Two patients (7.4%) required reinter vention for postoperative bleeding. Two cases (7.4%) had transient ren al dysfunction. One patient, with multiple organ failure, died on the 16th postoperative day (3.7%). Follow up was obtained in 26 patients ( 96.3%). Survival at 5 years was 80.6%, 95.7% of those patients were fr ee of any neurologic symptom. Combined carotid and coronary surgery is a safe treatment option for atheroesclerosis of multiple territories in selected patients; long term benefits are also obtained.