Simultaneous carotid endarterectomy and coronary artery bypass grafting in patients with bilateral carotid stenoses

Abstract

Objective. To assess the results of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Design and methods. 2257 patients (mean age 60,6 ± 4,8 years) underwent CABG during the period from 2003 to 2007. CEA was performed in 4,3 % (n = 97) of them. 83,2 % of patients preoperatively showed no neurological events. 2 groups were reviewed: Group 1 - 36 patients with unilateral carotid lesions, Group 2 - 61 patients with bilateral carotid lesions. Results. No strokes were registered in Group 1, 2,8 % of patients experienced myocardial infarction, perioperative mortality rate was 2,8 %. 9,8 % patients in Group 2 suffered stroke, 8,4 % - myocardial infarction, mortality rate was 6,6 %. The most significant neurological complications observed in Group 2 were present in patients with severe (90-100 %) contralateral carotid stenoses. The usage of hypothermical perfusion at the phase of CEA allowed to reduce mortality and stroke rate from 31,6 % to 7,1 %. Conclusions. The results of simultaneous CEA and CABG in patients with unilateral carotid lesions can be considered comparable with isolated CABG (mortality rate - 2,8 %, myocardial infarction - 2,8 %). The results of simultaneous CEA and CABG in patients with bilateral carotid lesions can be improved using hypothermical perfusion, however complication incidence remains rather high.