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Combined carotid and coronary surgery
1Open Heart Surgery Unit, University of Melbourne Teaching Hospitals, St Vincent's Hospital, Victoria, Australia.
The Australian and New Zealand Journal of Surgery
|September 1, 1987
Summary
Combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in high-risk patients showed a low permanent stroke rate of 2.6%. This combined procedure is a viable option for patients with severe coronary and carotid disease.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Patients with severe coronary artery disease (CAD) and extracranial carotid stenosis often require both coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA).
- The combined procedure aims to mitigate risks of myocardial infarction and cerebral ischemia in high-risk individuals.
Purpose of the Study:
- To determine the stroke rate associated with combined CEA/CABG procedures.
- To evaluate the safety and efficacy of performing CEA and CABG concurrently.
Main Methods:
- A retrospective review of 40 consecutive patients undergoing combined CEA/CABG was conducted.
- Patients had severe CAD and either signs of cerebral ischemia or asymptomatic carotid bruits.
- CEA was performed prior to CABG under a single general anesthetic.
Main Results:
- Six patients (15.4%) experienced postoperative cerebral ischemic events.
- These included reversible ischemic neurological deficit (7.7%), transient ischemic cerebral event (5.1%), and permanent stroke (2.6%).
- Two cardiac-related deaths occurred (5% mortality).
Conclusions:
- Combined CEA/CABG can be performed with a permanent stroke rate comparable to individual procedures.
- The procedure is a safe option for patients with combined coronary and carotid vascular disease at risk of infarction.
- Mortality for the combined procedure was 5%.