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Combined carotid endarterectomy and myocardial revascularization
H S Maki1, M E Kuehner, J F Ray
1Department of Surgery, Marshfield Clinic, Wisconsin 54449.
Insights
Combined carotid endarterectomy and myocardial revascularization is a safe procedure for patients with atherosclerosis. While restenosis occurs, it is often asymptomatic, highlighting the need for continued noninvasive monitoring.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Concomitant carotid artery and coronary artery atherosclerosis presents a complex surgical challenge.
- Combined surgical procedures aim to address both conditions simultaneously to improve patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of combined carotid endarterectomy and myocardial revascularization.
- To assess perioperative mortality and stroke rates associated with the combined procedure.
- To investigate the incidence and clinical significance of restenosis after carotid endarterectomy.
Main Methods:
- Retrospective review of 95 patients who underwent combined carotid endarterectomy and myocardial revascularization from February 1971 to December 1987.
- Analysis of mortality and postoperative stroke rates.
- Follow-up carotid duplex scans in 41 patients to assess for restenosis.
Main Results:
- Overall mortality rate was 4% and stroke rate was 2% over the 16-year study period.
- From 1980 to 1987, mortality and stroke rates decreased to 1% and 2%, respectively.
- Follow-up duplex scans revealed >50% restenosis in 25% of patients, with only two symptomatic cases.
Conclusions:
- Combined carotid endarterectomy and myocardial revascularization can be performed safely.
- The combined approach effectively manages concomitant carotid and coronary artery atherosclerosis.
- Noninvasive testing is crucial for monitoring restenosis rates and clinical outcomes.
Abstract:
From February 1971 through December 1987, 95 patients underwent combined carotid endarterectomy and myocardial revascularization. Mortality and postoperative stroke rates were 4 percent and 2 percent, respectively, for the 16-year experience. From 1980 to 1987, when 89 percent of patients had their operation, mortality and stroke rates were 1 percent and 2 percent, respectively. Follow-up carotid duplex scan in 41 patients revealed that 25 percent had more than 50 percent restenosis. Only two in this group were symptomatic. We conclude that the combined approach to concomitant carotid and coronary artery atherosclerosis can be done safely. Continued study with noninvasive testing is important to document restenosis rates.