Endartectomía carotídea simultánea con revascularización miocárdica: experiencia en 27 pacientes / Carotid endartectomy simultaneous with myocardial revascularization: experience in 27 patients

ABSTRACT

Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarction can occur after carotid endartectomy and stroke is a well documented morbidity of coronary artery bypass grafting. To optimize results, we have performed concomitant carotid endartectomy and myocardial revascularization in selected cases, with severe disease in both territories. During a 13 year period, 27 patients were submitted for this procedure, 21 (77,8 percent) were male and the average age was 67.6 years (range 59-81). All patients had high grade internal carotid artery stenosis, 5 (18.5 percent) were symptomatic. Coronary artery disease symptoms were unstable angina in 12 patients (44,4 percent) and effort angina in 15 (55.6 percent). Two patients (7.4 percent) required reintervention for postoperative bleedinng. Two patients (7.4 percent) had transient renal dysfunction. One patient, with multiple organ failure, died on the 16th postoperative day (3.7 percent). Follow up was obtained in 26 patients (96.3 percent). Survival at 5 years was 80.6 percent, 95.7 percent of those patients were free of any neurologic symptoms. Combined carotid and coronary surgery is a safe treatment option for atherosclerosis of multiple territories in selected patients, long term benefits are also obtained