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Long-Term Results of Simultaneous Carotid Endarterectomy and Coronary Artery Revascularization in Patients with Unstable Angina and Cerebrovascular Insufficiency

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

Aurel C. Cernaianu

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

Teimuraz Gaprindashvili

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

John G. Gallucci

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

Jonathan H. Cilley, JR

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

Michael A. Grosso

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

Anthony J. DelRossi

Division of Cardiothoracic Surgery Cooper Hospital/University Medical Center 3 Cooper Plaza, Suite 411 Camden, NJ 08103

This study assessed the outcome of 11 consecutive high-risk patients (8 men, 3 women) with symptomatic, high-grade (greater than 70%) bilateral carotid stenosis and left main or triple-vessel disease with unstable angina undergoing emergency simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) revascularization. Seven patients presented with crescendo unstable angina and 4 had type III postinfarc tion unstable angina. All were symptomatic for cerebrovascular insufficiency. Six patients had left main and 5 patients had triple-vessel disease aside from bilateral carotid lesions. There were 8 men and 3 women, (mean age 69.1 ± 3.9 years). The mean preoperative end-diastolic pressure and ejection fraction were 17.2 ±2.4 mm Hg and 35.3 ±6.9%, respectively.

Sequential reconstruction of the carotid artery was followed by CABG with an average number of 3.1 ± 0.3 grafts per patient. One patient had additional aortic valve replace ment and 1 had an automatic implantable cardioverter defibrillator implanted. There was no operative mortality. The overall neurologic complication rate was 27.3% (3 of 11). One patient developed perioperative myocardial infarction and 1 other had respira tory failure. Mean postoperative hospital stay was 24.4 ±4.8 days.

Within one year postoperation, 1 patient died. Two patients had contralateral CEA owing to recurrent transient ischemic attack. The five-year probability of survival was 89%. Our data show that simultaneous CEA/CABG in patients with high-risk coronary and cerebrovascular insufficiency may result in low mortality; however, a relatively increased incidence of short- and long-term morbidity is expected.

Vascular and Endovascular Surgery, Vol. 28, No. 9, 577-580 (1994)
DOI: 10.1177/153857449402800901


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