[Revascularization for simultaneous carotid and coronary ischemia].

Some of the patients who suffer from cerebral ischemia may at the same time have coronary insufficiency. For such cases, not only extracranial-intracranial (EC-IC) bypass but also cardiac revascularization is considered to be necessary. One-stage surgery of both carotid endarterectomy and coronary artery bypass grafting (CABG) has not infrequently been published. However, the combination of EC-IC bypass and CABG is rarely reported in the literature. The indication of EC-IC bypass and/or CABG for such patients above stated has been searched for. In fact, CABG runs the risk of aggravating cerebral ischemia and/or intracranial hemorrhage by inevitable hypotension, hypothermia and heparinization of a large amount, while EC-IC bypass may safely be carried out so long as cardiac conditions are carefully controlled during the operation. It is consequently presumed that the preliminary EC-IC bypass followed by CABG seems to be the method of choice for simultaneous carotid and coronary ischemia. Two cases underwent the staged revascularization, first for the brain and next for the heart, with a successful result are reported in the present paper.