The Experience of Simultaneous Carotid Endarterectomy and Myocardial Revascularization

Between January 1988 and April 1994, simultaneous carotid endarterectomy and myocardial revascularization were performed in 20 patients (16 men and 4 women) with a mean age of 67.38 ± 11 years (range : fifty-six to seventy-eight years). The neurologic presentations included asymptomatic carotid bruit in 4 patients (20%), history of transient ischemic attack (TIA) in 11 (55%), and previous stroke with recent history of TIA in 5 (25%). Preoperatively, 14 patients (70%) were in New York Heart Association functional class III, with the remainder in either class I (5%) or class II (25%). Coronary arteriography demonstrated severe coronary atherosclerosis involving a double-vessel disease in 4 patients (20%), and triple-vessel disease in 16 (80%). Two patients (10%) had left main coronary artery stenosis, and 4 had previous recent myocardial infarction. All patients received unilateral carotid endarterectomy and a mean number of 3.5 distal anastomoses of coronary arteries. No patient died within thirty days after simultaneous operation, and operative mortality rate was zero. The late mortality rate was 20%, with only 1 death related to myocardial infarction and 1 attributable to contralateral stroke. According to a proposed guideline, the long-term outcome is determined by the extent and severity of the cardiovascular disease. Simultaneous operation is appropriate for a subgroup of patients with coexisting carotid and coronary artery disease.