Management of Coexistent Carotid and Coronary Artery Atherosclerotic Disease: An Unresolved Controversy: Report of Clinical Experience and Literature Review

Abstract

The outcomes of 44 patients undergoing concomitant carotid endarterecto my and coronary artery bypass grafting were reviewed along with significant liter ature to date. In the 44 patients receiving concomitant procedures there were no deaths, no myocardial infarctions, 3 transient neurologic deficits (6.8%), and 1 permanent neurologic deficit (2%). In the world experience with concomitant procedures, the incidence of myocardial infarction is 3.7% (64 of 1742) and the incidence of cerebral infarction is 6.7% (116 of 1742). These results compare favorably with an incidence of myocardial infarction as high as 20% in similar patients undergoing isolated carotid endarterectomy, and similarly, to an inci dence of cerebral infarction as high as 25% in similar patients undergoing iso lated coronary artery bypass grafting. Concomitant carotid endarterectomy and coronary artery bypass grafting offers an approach to the management of coex istent carotid and coronary artery occlusive disease with improved results when compared with isolated or staged procedures performed in the setting of coexis tent disease. A rational approach for preoperative evaluation is suggested that emphasizes the value of noninvasive carotid testing.