Combined myocardial and cerebral revascularization. A ten year experience

We report on the results of combined carotid endarterectomy and coronary artery bypass grafting in 82 patients. Vascular pathology was severe in these cases: 94% of patients had extensive multivessel coronary artery disease, 29% had unstable angina, 30% had severe left main stem stenosis and all patients had hemodynamically significant stenosis of at least one carotid artery, 13% had an additional occlusion of the contralateral internal or common carotid artery and 26% had severe bilateral carotid artery stenosis. The carotid lesion was asymptomatic in 64% of cases, 24% of the patients experienced previous transient cerebral ischemia and 12% of the patients had a history of completed stroke. Hospital mortality was 7.3%. Neurological deficit occurred in 7.3% but functional impairment was not permanent. Late results have been obtained for 76 survivors at a mean postoperative interval of 29 months. Five year life table survival rate was 86%. Follow-up showed that 3 patients (4%) have died and that 3 patients (4%) experienced a late neurologic event (one TIA; two strokes) but none of these events involved the cerebral cortex on the side of the carotid endarterectomy. The cumulative 5 year stroke free survival rate is 91%. We conclude that combined carotid endarterectomy and coronary artery bypass grafting can be done with an acceptable mortality rate in these critically ill patients and that the postoperative incidence of neurological events is low.