Patient selection and results of simultaneous coronary and carotid artery procedures

The high incidence of severe coronary artery disease in patients with symptomatic carotid artery disease makes careful evaluation of both carotid and coronary systems important to the successful short-term and long-term management of these patients. We have established guidelines for patient evaluation and procedure selection based on symptomatic assessment of each system, supplemented by angiographic and hemodynamic data. With this information, three operative groups are established: (1) carotid artery operation first or alone, (2) coronary artery bypass grafting first followed by carotid artery operation, and (3) simultaneous carotid artery and coronary artery bypass procedures. The benefit of this selection process has been shown by the low operative mortality in each group. This report presents our selection process and evaluates the results for 21 patients in the group having simultaneous carotid and coronary artery procedures.