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Rationale for simultaneous carotid endarterectomy and aortocoronary bypass
R S Lord1, A R Graham, M X Shanahan
1Department of Professional, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
Insights
Simultaneous carotid and coronary revascularization in 78 patients showed a 6.4% stroke or death rate. This combined procedure offers a better alternative than staged operations for patients with severe carotid stenosis.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Coexistent carotid and coronary artery disease presents a complex management challenge.
- Simultaneous surgical intervention aims to address both conditions concurrently.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous carotid and coronary artery reconstructions.
- To compare outcomes of combined procedures versus staged interventions.
Main Methods:
- Seventy-eight patients underwent simultaneous carotid and coronary artery reconstructions.
- Outcomes including mortality, stroke, and myocardial infarction were analyzed.
Main Results:
- The overall stroke or death incidence was 6.4% (5 deaths, 4 perioperative strokes).
- Myocardial infarction occurred in 3.8% of patients.
- Analysis of 36 recent cases suggested a minimal increase in stroke or death rate compared to isolated carotid endarterectomy.
Conclusions:
- Simultaneous carotid and coronary revascularization is a viable option for patients with severe carotid stenosis.
- This approach may offer better outcomes than staged procedures, avoiding refusal of carotid endarterectomy.
Abstract:
Seventy-eight patients were treated for coexistent carotid and coronary stenosis by simultaneous reconstructions. Five patients died (6.4%), one from a stroke contralateral to the carotid reconstruction. Four others suffered a perioperative stroke (total stroke incidence 6.4%). Three myocardial infarctions occurred (3.8%) including one fatal infarct. Analysis of the most recent 36 combined reconstructions indicates that the extramorbidity in this group increased the stroke or death rate for all carotid endarterectomies carried out in the same period by only 1%. Alternatively if these patients had been operated upon by aortocoronary grafting alone the mortality would have increased by 0.1% assuming no neurologic complications. Since these 36 patients had severe carotid stenosis and would have been refused carotid endarterectomy as an isolated procedure the results seem better than would have been achieved by staged operations.