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Published on: January 23, 2019

Combined carotid endarterectomy and myocardial revascularization: personal experience

R Chiesa1, G Melissano, R Castellano

  • 1Institute for Cardiovascular and Respiratory Disease, University of Milan, IRCCS, 11. San Raffaele, Via Olgettina, 60, 1-20131 Milano, Italy.

Archives of Gerontology and Geriatrics
|January 1, 1995
PubMed

Insights

Simultaneous coronary artery bypass graft (CABG) and carotid endarterectomy is recommended for patients with unstable angina and symptomatic carotid artery disease. For asymptomatic stenosis, clinical judgment guides the decision.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Patients undergoing myocardial revascularization often have coexisting extracranial cerebrovascular disease, increasing stroke risk.
  • Combined coronary artery bypass graft (CABG) and carotid endarterectomy (CEA) procedures have been performed for two decades, but indications and timing remain debated.

Purpose of the Study:

  • To evaluate the safety and efficacy of simultaneous CABG and CEA.
  • To determine clinical indications for combined procedures in patients with coronary and carotid artery disease.

Main Methods:

  • Retrospective analysis of 1122 myocardial revascularization patients between November 1988 and January 1994.
  • 35 patients underwent simultaneous CABG and CEA; 502 patients had isolated CEAs.
  • Patient data included coronary artery disease severity, ejection fraction, and procedural outcomes.

Main Results:

  • Hospital mortality was 5.7% and major neurologic morbidity was 2.8% in the simultaneous group.
  • Trivascular coronary artery disease was present in 27 patients, and low ejection fraction in six.
  • Patients received an average of 3.7 coronary grafts during simultaneous procedures.

Conclusions:

  • A simultaneous approach is advised for patients with unstable angina and symptomatic carotid artery disease.
  • For critical but asymptomatic carotid stenosis, the decision for combined surgery requires individualized clinical assessment.
  • Combined CABG and CEA can be performed with acceptable outcomes in selected patient populations.

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