[Associated coronary and carotid atheroma. Implications and current role of indications for double surgery].

Coronary insufficiency is responsible for part of the peri-operative mortality of carotid surgery and it is by far the principal long term cause of death. Conversely, cerebral vascular accidents due to extra-cranial carotid stenosis compromise the results of myocardial revascularisation operations less than coronary insufficiency itself. Patients who require double surgery can be recognised on the basis of the clinical findings. The essential indication for this surgery is double clinical instability. Apart from these patients, the group of patients at high risk still need to be defined. Strictly preventative coronary and carotid surgery seem to be less justified, particularly as the currently available prophylactic measures and medical treatments appear to achieve a relative improvement in the long term prognosis of these patients with multiple vessel disease.