Coronary artery bypass and carotid endarterectomy: combined approach

Controversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004), and history of prior neurologic events (p=0.0001). Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery surgery group (p=0.046). Patients with concomitant carotid and coronary artery disease have an advanced arteriosclerosis. Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction than simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity.