Coexistent carotid and coronary artery disease. Surgical management

We performed simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) in 42 patients (average age, 61 years). Twenty-nine patients had preoperative transient ischemic attacks. Carotid arteriography showed stenosis (greater than 70%) in 38 subjects and extensive ulcerated lesions in two, and two emergency patients were not studied. Carotid artery dissection and sternotomy were simultaneously performed and the patients were cannulated for cardiopulmonary bypass (CPB). We undertook CE (22 left and 24 right) using EEG monitoring prior to CPB in all but one patient. The average carotid occlusion time was 25 minutes without a shunt in 23 patients and 5.5 minutes with a shunt in 19 patients. After CE, CABG was performed with an average aortic clamp time of 39 minutes and an average CPB time of 87 minutes. The operative mortality was 5% (2/42). There were no strokes or perioperative myocardial infarctions. Neurologic morbidity consisted of postoperative headache in one patient, transient upper-extremity weakness in two patients, and transient facial weakness in one patient. The average length of postoperative hospitalization was ten days. Currently, patients with symptomatic coronary artery disease and concomitant carotid bruits with positive noninvasive testing and arteriography should have simultaneous repair of these lesions.