Pomè G, Passini L, Colucci V, Taglieri C, Arena O, Collice M, Pellegrini A
Department of Cardiac Surgery, ospedale Niguarda Ca Granda, Milan, Italy.
J Cardiovasc Surg (Torino). 1991 Nov-Dec;32(6):787-93.
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.
1981年至1990年间，对52例患者（平均年龄61岁）实施了冠状动脉搭桥术与颈动脉内膜切除术。其中，36例（69%）患有III-IV级功能性心绞痛，33例（63%）患有三支血管病变，36例（69%）有过一次或多次心肌梗死，33例（63%）左心室功能异常。4例患者还接受了其他心脏手术。29例患者（56%）记录有无症状性颈动脉狭窄，其余23例（44%）有过脑血管症状。所有患者至少有一条颈动脉存在血流动力学显著狭窄，17例（33%）有严重双侧颈动脉狭窄，6例（11%）对侧颈内动脉有额外闭塞。无早期死亡病例。围手术期发病率包括：4例患者（7.7%）发生心肌梗死，3例（5.7%）出现神经功能缺损，但功能损害并非永久性。已获得所有52例患者的远期结果，术后平均随访间隔为35个月。4例患者（7.7%）死亡，5年生命表生存率为83%。5年时，精算曲线显示67%的患者无所有严重事件或死亡。晚期死亡率和发病率主要与冠状动脉疾病进展有关。我们得出结论，对于冠状动脉搭桥术候选患者，同时行严重颈动脉狭窄内膜切除术可安全进行，且对患者而言更具实用性。
