Combined Carotid and Coronary Artery Surgery

Simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) were performed on 133 patients over an eight-year period. Twenty-seven patients (20%) had previous TIAs, 12 (9%) had previous strokes, the remainder were asymptomatic (71%). All asymptomatic patients had greater than 85% stenosis of the internal carotid artery demonstrated by noninvasive ultrasound and four-vessel angiography. CE was performed prior to the sternotomy for coronary artery bypass under the same anesthesia. Nineteen patients had bilateral carotid artery disease. Postoperatively three patients suffered strokes (2.2%), an additional three patients (2.2%) suffered transient upper extremity weakness; one patient from each of these groups died. There were no post-op strokes or TIAs in patients with bilateral carotid artery disease. Average length cf hospital stay was 10 days. Our experiences lead us to conclude that the morbidity/mortality of the simultaneous procedure is not affected by bilateral carotid artery disease. We believe that in patients with symptomatic coronary artery disease and symptomatic carotid artery disease, or asymptomatic carotid artery disease with a high grade stenosis, simultaneous repair of both lesions should be undertaken.