[Influence of coronary disease on the results of carotid surgery]

The object of this retrospective (case-control) study of 513 carotid artery operations in 471 patients was to evaluate whether the presence of coronary artery disease at the time the decision to operate was taken, influence the prognosis of patients operated upon for stenosis of a carotid artery. Three groups were constituted and compared; no coronary artery disease (NC), stable coronary artery disease (CS) and unstable coronary artery disease (CI). Operative mortality was 1% (NC), 5% (CS) and 9% (CI) respectively (p < 0.001). The rate of neurologic deficits was 1.3% (NC), 2.4% (CS) and 3.1% (CI), and the 5 year actuarial survival rate 83% (NC), 78% (CS) and 63% (CI) (p = 0.040 by the Log-Rank test). Premature deaths were due to cardiac and neurologic causes. In the patients with coronary disease, local and regional anesthesia was followed by 0% mortality whereas the rate was 3% (CS) and 13% (CI) (p < 0.001) after general anesthesia. The cause of delayed death was determined accurately in 50% of cases; it was cardiac in 25% (NC) and 70% in patients with coronary disease. Results of the present study confirm that the presence of coronary disease has an adverse effect on the immediate and long term prognosis for patients undergoing coronary artery surgery, and demonstrate that the operative risk can be significantly reduced by the use of local and regional anesthesia. Long term close cardiology surveillance is justified, particularly if signs of coronary disease are noted perioperatively.