COMBINED CAROTID ENDARTERECTOMY AND CORONARY-ARTERY BYPASS-GRAFTING DOES NOT INCREASE THE RISK OF PERIOPERATIVE STROKE

Patients who present for coronary artery bypass grafting with hemodyna mically significant carotid artery lesions pose a difficult problem fo r both the cardiac and vascular surgeons. There is no consensus as to the proper management of these patients despite numerous studies. Pros pective collection of data was performed in patients undergoing combin ed carotid endarterectomy and coronary artery bypass grafting's from A pril 1980 to November 1996, A total of 470 simultaneous carotid endart erectomy's and coronary artery bypass grafting's were performed in 420 patients. The average age of the patient was 69 years, with 62% being male, 15% being diabetic and 38% being smokers. Sixty (13%) presented with Transient ischemic attacks, 22 (5%) presented with amaurosis fug ax, 16 (3.4%) presented with a prior history of stroke and 372 (70%) w ere asymptomatic. Operative mortality was 2.4% or 10 patients: 90% of those patients died from cardiac complications postoperatively and one patient died of a stroke. Permanent neurological deficits occurred in five (1%) of the patients, and six (1.7%) of the patients had a trans ient neurological deficit that improved prior to discharge. In conclus ion, in our experience simultaneous carotid endarterectomy with corona ry artery bypass grafting can be performed with an acceptable mortalit y and morbidity and does not appear to put the patient at a higher ris k than when either procedure is performed alone. (C) 1998 The Internat ional Society for Cardiovascular Surgery. Published by Elsevier Scienc e Ltd. All rights reserved.