Background. Surgical management of patients presenting for coronary artery
bypass grafting with significant bilateral carotid artery stenosis has not
been well defined. In this study, our preliminary results of coronary arter
y bypass grafting with concomitant bilateral carotid endarterectomy have be
en reviewed.
Methods. A retrospective nonrandomized chart review was performed in 33 pat
ients with unstable angina and bilateral carotid artery stenosis, more than
70%, undergoing simultaneous corollary artery bypass grafting and bilatera
l carotid endarterectomy using an eversion technique.
Results. Concomitant coronary artery bypass grafting with bilateral carotid
endarterectomy was performed urgently in 24 (73%) and electively in 9 (27%
) patients. The average carotid artery cross-clamp and total perfusion time
s were 14.7 +/- 4.9 minutes and 123 +/- 29.2 minutes, respectively. The ave
rage length of stay in the cardiopulmonary intensive care unit was 4.2 +/-
14.2 days and total hospital stay was 16.2 +/- 20.5 days. Postoperative in-
hospital stay was 14.9 +/- 20.3 days. There were no postoperative strokes.
Twenty-one (64%) patients were discharged before the tenth postoperative da
y. Nonfatal postoperative complications occurred in 27% (9 of 33) of patien
ts. The overall 30-day mortality was 6.1% (2 of 33) and that was unrelated
to primary cardiac or cerebrovascular events.
Conclusions. Favorable outcome supports the justification for performing co
ncomitant coronary artery bypass grafting with bilateral carotid endarterec
tomies in selected patients. (C) 2001 by The Society of Thoracic Surgeons.