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A surgical approach to coexistent coronary and carotid artery disease
M Jahangiri1, G M Rees, S J Edmondson
1Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London.
Insights
Combined coronary artery bypass graft surgery and carotid endarterectomy showed good early results. This combined approach for patients with significant carotid disease is safe and effective.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
Background:
- Patients requiring coronary artery bypass graft (CABG) surgery often have coexistent carotid artery disease.
- Significant carotid stenosis poses a risk of stroke during cardiac procedures.
Purpose of the Study:
- To evaluate the early outcomes of performing CABG surgery and carotid endarterectomy (CEA) concurrently.
- To assess the safety and efficacy of a combined surgical approach.
Main Methods:
- A retrospective analysis of 64 patients undergoing combined CEA and CABG surgery between June 1987 and March 1995.
- CEA was performed first, followed by CABG surgery during a single anesthetic period.
- Outcomes assessed included stroke, transient ischemic attack, and myocardial infarction.
Main Results:
- Successful myocardial revascularization was achieved in all 64 patients.
- No perioperative myocardial infarctions occurred.
- A 4.7% incidence of new postoperative neurological deficits was observed, with most patients recovering fully before discharge.
Conclusions:
- Combined CEA and CABG surgery can be performed safely.
- The combined procedure yields favorable early results for patients with significant carotid and coronary artery disease.
Objective:
To assess the early results of combined coronary artery bypass graft surgery and carotid endarterectomy.
Design:
Retrospective and ongoing analysis of patients who underwent combined coronary artery bypass graft surgery and carotid endarterectomy.
Setting:
Cardiothoracic unit in a London teaching hospital.
Patients:
From June 1987 to March 1995, 64 patients were identified. They were patients who were scheduled to have coronary artery bypass graft surgery or required urgent coronary revascularisation and who were found to have significant coexistent carotid disease. (Unilateral carotid stenosis > 70%, bilateral carotid stenosis > 50%, or unilateral carotid stenosis > 50% with contralateral occlusion.)
Interventions:
Both procedures were performed during one anaesthesia: the carotid endarterectomy was performed first without cardiopulmonary bypass. After completion of carotid endarterectomy, coronary artery bypass graft surgery was performed.
Main Outcome Measures:
The incidence of stroke, transient ischaemic attack, and myocardial infarction in the early postoperative period was analysed.
Results:
Myocardial revascularisation was successful in all 64 patients. There were no perioperative infarcts. In three patients (4.7%) a new neurological deficit developed postoperatively: two recovered fully before hospital discharge.
Conclusions:
Combined coronary artery bypass graft surgery and carotid endarterectomy were performed safely and with good results.