Surgical Approach of Concomitant Coronary and Carotid Artery Disease

ABSTRACT

PURPOSE: A definite guideline for the surgical approach to patients suffering with combined coronary and carotid artery disease remains controversial. The aim of this study was to compare the cardiovascular and neurologic complications between the staged approach and the synchronous approach. METHODS: This study reviewed the outcomes following each procedure in 17 cases from 1995 to 2004; 8 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) (group I), 6 patients underwent CEA followed by CABG (group II) and the remaining 3 patients underwent CABG followed by CEA (group III). RESULTS: In group I, the mean percentage of internal carotid artery stenosis was 77.9%. Preoperatively, 3 patients had neurologic symptoms, and all the cases had triple vessel disease. Off-pump CABG (OPCABG) was performed for 4 cases. In group II, the mean percentage of internal carotid artery stenosis at the time of CEA was 78.7%; all cases had triple vessel disease and/or left mainstem coronary artery disease and 4 cases had neurologic symptoms. OPCABG was performed for 1 case. In group III, the mean percentage of internal carotid artery stenosis at the time of CABG was 76.7%. One patient had neurologic symptoms;all cases had triple vessel disease. OPCABG was performed for 2 cases. Neurologic complication occurred in 1 patient of group III. CONCLUSION: Because the data was reviewed retrospectively, there were limitations for understanding the reasons for the staged or synchronous approach. However, we obtained the result that the synchronous approach resulted in fewer perioperative neurologic complications and this might be a good operative strategy, while OPCABG allowed the use of the synchronous approach.