Safety and efficacy of one stage coronary artery bypass grafting and carotid endarterectomy

ABSTRACT

To review the results of safety and efficacy of one stage coronary artery bypass grafting and carotid endarterectomy. In the absence of clear recommendations, without any bias, and by surgeon preference for the management of individualized cases, between January 1999 and July 2008, only 17 out of around 400 with a concomitant atherosclerotic disease in both vascular territories underwent one stage carotid endarterectomy and coronary artery bypass grafting. The mean age of the studied group was 67 [range 54-77] years, there were 16 males and one female, all of the 17 patients were at high risk with a mean simple additive EuroScore of eight [range 7-11]. Twelve out of 17 patients had three vessel coronary artery disease, 4/17 patients had four vessel coronary artery disease, and 1/17 patients had two vessel coronary artery disease. Regarding carotid occlusive disease, 10/17 patients were asymptomatic and only 7/17 were symptomatic, four of these symptomatic patients had an old cerebrovascular accident, 10/17 patients had unilateral significant carotid lesion, 6/17 patients had bilateral significant carotid lesion, while 1/17 patient had unilateral ulcerated unstable carotid lesion. All 17 patients underwent preoperative duplex Doppler carotid ultrasound and/or four-vessel arch arteriography, and standard coronary angiography. The principal indications for the combined procedure were the need for coronary artery bypass grafting and either [1] symptomatic carotid artery disease with unilateral or bilateral stenosis > 50% in 6/17 patients, [2] asymptomatic internal carotid artery stenosis of 80% or more, with or without contralateral disease in 10/17 patients, or [3] an ulcerated, unstable internal carotid artery lesion, regardless of degree of stenosis in 1/17 patient. Simple descriptive statistics were used. The average degree of carotid stenosis on the operated side was 72.5% [range 60-90%]. The average number of bypassed coronary arteries is 3.4 [range 2-4] per patient. There were no postoperative myocardial infarctions or strokes and only one death [5.5%] at a mean follow up period of 2.1 years [range 3 months - 4.5 years]. In our practice, simultaneous carotid endarterectomy and coronary artery bypass grafting seems to be a safe surgical approach for these high-risk patients