PMID: 15374263Jan 1, 1995Paper

Combined carotid endarterectomy and myocardial revascularization: personal experience

Archives of Gerontology and Geriatrics
R ChiesaA Grossi

Abstract

A significant percentage of patients undergoing myocardial revascularization suffer from extracranial cerebrovascular disease; recognition of such combined lesions identifies patients at risk for cerebrovascular accidents during the cardiac procedure. Simultaneous or staged coronary artery bypass graft (CABG) and carotid endarterectomy operations have been performed for the last 20 years, however, the clinical indications and the timing of the procedures remain controversial issues. Between November 1988 and January 1994, 1122 patients underwent myocardial revascularization at our Institute and in 35 cases (3.7%) carotid endarterectomy was simultaneously performed; 502 isolated carotid endarterectomies were performed in the same period. Trivascular coronary artery disease was found in 27 cases and low ejection fraction in six. Each patient received an average of 3.7 coronary grafts. Hospital mortality was 5.7% and major neurologic morbidity 2.8%. We believe that a simultaneous approach is recommended in patients with unstable angina and symptomatic carotid artery disease; in patients with a critical but asymptomatic carotid artery stenosis the indication for operation is subject to individual clinical judgment.

References

Nov 1, 1976·Stroke; a Journal of Cerebral Circulation·J V BoundsD A Barnhorst
Aug 15, 1991·The New England Journal of Medicine·UNKNOWN North American Symptomatic Carotid Endarterectomy Trial CollaboratorsM Eliasziw
Nov 1, 1989·American Journal of Surgery·H S MakiJ F Ray
Dec 1, 1972·Archives of Surgery·V M BernhardJ J Peterson
Sep 1, 1984·Stroke; a Journal of Cerebral Circulation·A J Furlan, A C Breuer

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