Single staged carotid and coronary arteries surgery. Indications and results

The frequency of associated carotid and coronary stenosis is estimated to be 40% of cases including asymptomatic patients. The risk of death by myocardial infarction during carotid surgery is in the neighborhood of 1%. With Doppler and ultrasonic imaging, it is now possible to recognize carotid stenosis in 11% of these cases. Depending on the extent of the clinical manifestations caused by one or the other of these lesions, there are several therapeutic options: surgery of the carotid with special protection of the myocardium during and after surgery or simultaneous carotid and coronary surgery in high risk cases. Between 1979 and 1986, simultaneous surgery was performed in 18 cases in our department. During the same period, 1194 carotid endarterectomies and 505 coronary bypasses were performed. These 18 cases included 13 males and 5 females with a mean age of 62 years (range: 43 to 78 years). The procedure performed in these cases were 17 carotid endarterectomies, one bypass of the innominate artery and an average of 2 aorto-coronary bypasses per patient. One death from myocardial infarction occurred in the immediate postoperative period and another patient died suddenly 8 months later. The evolution of arterial disease was evaluated in the other patients. Simultaneous carotid and coronary artery surgery is indicated in high risk carotid and coronary patients. Perusal of the results in the literature allows a better appreciation of the indications and risks of this type of surgery. Our series indicates the necessity for a careful preoperative workup in these patients and the need for more accurate screening to obtain better results.