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Combined coronary artery bypass grafting and carotid endarterectomy
M Vicaretti1, J P Fletcher, P Klineberg
1Division of Surgery, Westmead Hospital, NSW, Australia.
Insights
Combined carotid endarterectomy and coronary artery bypass grafting is a viable procedure for select patients. This surgical approach demonstrated acceptable neurological risks, though it did not eliminate cardiac mortality.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
Background:
- Patients with concurrent carotid artery disease and coronary artery disease present complex treatment challenges.
- Symptomatic carotid artery disease necessitates intervention to prevent stroke.
- Coronary artery disease, particularly severe forms, requires surgical revascularization.
Purpose of the Study:
- To evaluate the safety and efficacy of combined carotid endarterectomy and coronary artery bypass grafting.
- To assess the neurological and cardiac outcomes of the combined surgical approach.
Main Methods:
- A retrospective review of 52 patients undergoing combined carotid endarterectomy followed by coronary artery bypass grafting between 1982 and 1994.
- Patients presented with varying degrees of coronary artery disease (angina, triple-vessel disease, left main disease) and carotid artery disease (symptomatic, asymptomatic).
Main Results:
- The combined procedure had a 5.8% postoperative mortality rate (3 deaths: 2 cardiac, 1 neurological).
- One patient (1.9%) experienced a permanent neurological deficit.
- The majority of patients had stable or unstable angina, with significant coronary and carotid artery disease.
Conclusions:
- Combined carotid endarterectomy and coronary artery bypass grafting is feasible in carefully selected patients.
- The procedure offers acceptable neurological morbidity.
- Cardiac mortality remains a significant concern and is not fully addressed by the combined surgical strategy.
Abstract:
Combined carotid endarterectomy and coronary artery bypass grafting was performed in 52 patients between January 1982 and September 1994. Forty-nine patients had stable or unstable angina and three had symptom-free coronary artery disease detected by stress testing. Thirty-one patients had triple-vessel disease and 17 had left main trunk or left main equivalent coronary artery disease. Five patients had symptom-free carotid artery disease, 12 had non-specific neurological symptoms, and 35 had transient ischaemic attacks. Carotid endarterectomy was performed first, followed by coronary artery bypass grafting. There were three postoperative deaths, two cardiac and one neurological, for a mortality rate of 5.8%. One patient suffered a permanent neurological deficit (1.9%). It is concluded that combined carotid endarterectomy/coronary artery bypass grafting can be performed in selected patients with acceptable neurological morbidity, although cardiac mortality was not eliminated by the combined approach.