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 simulta neous 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.