Synchronous carotid endarterectomy and myocardial revascularization

The management of the coexisting extracranial carotid and coronary disease is still controversial. We reviewed our experience in synchronous operation for both diseases in Veterans General Hospital-Taipei.

From Jan. 1988 to Nov. 1992, the synchronous carotid endarterectomy and myocardial revascularization were performed in nine patients with the mean age of 66.6 +/- 11 years. Five had symptomatic extracranial vascular disease or stabilized neurological deficits, and four had asymptomatic carotid bruits. Four had bilateral hemodynamically significant carotid stenosis. NYHA functional class III-IV was noted in three patients. Triple-vessel coronary disease was documented in 6 patients including one with left main lesion more than 50%. Eight had previous or recent myocardial infarction and four had moderate to severe left ventricular dysfunction noted on left ventriculography.

All nine patients received unilateral carotid endarterectomy and a mean number of 2.8 distal anastomosis. Operative number of 2.8 distal anastomosis. Operative mortality within 30 days was zero and morbidity was noted in two patients. One patient was CVA and the other one was perioperative myocardial infarction. Late mortality occurred in previous two patients with morbidity. Late morbidity was mainly due to cardiac rather than neurological problems.

If long-term natural history of coronary or carotid artery disease could be actually altered by surgery, a systemic evaluation for possible multifocal atherosclerosis is mandatory. By following a proposed guideline, synchronous operation is appropriate for a subgroup of patients with coexisting carotid and coronary artery disease.