Coronary artery bypass combined with bilateral carotid endarterectomy

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.