Combined surgical approach to coexistent carotid and coronary artery disease.

Combined coronary artery bypass and carotid endarterectomy were performed in 52 patients (mean age 61 years) between 1981 and 1990. Of these, 36 (69%) had functional class III-IV angina pectoris, 33 (63%) had triple-vessel disease, 36 (69%) had one, or more, previous myocardial infarctions, and 33 (63%) had an abnormal left ventricular function. In 4 cases, additional cardiac procedures were performed. Asymptomatic carotid stenosis was documented in 29 patients (56%) and the remaining 23 (44%) had experienced cerebrovascular symptoms. All patients had hemodynamically significant stenosis of at least one carotid artery, 17 (33%) had severe bilateral carotid artery stenosis, and 6 (11%) had an additional occlusion of the contralateral internal carotid artery. There were no early deaths. Perioperative morbidity included: myocardial infarction in 4 patients (7.7%) and neurological deficit in 3 (5.7%) but functional impairment was not permanent. Late results have been obtained for all 52 patients at a mean postoperative interval of 35 months. Four patients (7.7%) have died, and the 5 year life-table survival rate was 83%. At five years, actuarial curves showed 67% of patients to be free of all serious events or death. Late mortality and morbidity were related above all to the progression of the coronary artery disease. We concluded that simultaneous endarterectomy of significant carotid artery stenosis in candidates for coronary bypass can be done safely and considered as more practical for the patient.