CAROTID ENDARTERECTOMY CAN BE SAFELY PERFORMED WITH ACCEPTABLE MORTALITY AND MORBIDITY IN PATIENTS REQUIRING CORONARY-ARTERY BYPASS GRAFTS

BACKGROUND: Patients undergoing the placement of coronary artery bypas s grafts (CABG) with hemodynamically significant carotid artery lesion s pose a difficult problem for both cardiac and vascular surgeons. Des pite numerous studies, there has been no consensus of opinion as to th e proper management of these patients. In numerous series, the combine d mortality and perioperative stroke rates in concomitant carotid enda rterectomy and CABG procedures have ranged from 8% to 40%. This has ma de many surgeons consider staging these procedures. METHODS: Retrospec tive analysis of patients undergoing combined carotid endarterectomies and CABG from 1980 to 1993 were reviewed. Two hundred six procedures were performed in 189 patients. Seventeen patients had bilateral carot id endarterectomy performed with CABG. The average age of our patient population was 66 years, with 123 being male and 66 being female. Seve nty-five percent of the patients were asymptomatic with the remainder having transient ischemic attacks, amaurosis fugax, or Drier stroke. R ESULTS: Operative mortality was 2%, with three of four patients dying of cardiac failure and one of a stroke. A temporary neurologic deficit was seen in 2% of patients, and a permanent neurologic deficit was se en in 2 of 206, or 1%. Thirty shunts were used inn this series, mostly in patients with contralateral carotid occlusion. Ah procedures were performed under general anesthesia with full invasive monitoring. One patient was re-explored for bleeding, and one patient had a temporary hypoglossal palsy. A total of 203 cases had the arteriotomies closed p rimarily, and 3 required patches. CONCLUSION: In our experience, simul taneous carotid endarterectomy and CABG can he performed with an accep table mortality and morbidity and does not appear to put the patient a t an increased risk. Staging of these procedures may not be necessary in most cages.