ACTA FAC. MED. NAISS. 2005; 22 (1):3-7

   Original article

       SIMULTANEOUS TREATMENT OF CAROTID AND CORONARY ARTERY DISEASE: CURRENT CONCEPT AND RESULTS OVER THE PAST 5 YEARS

Mario Lachat
Clinic for Cardiovascular Surgery, Zurich University Hospital, Switzerland

    SUMMARY
    Combined carotid artery endarterectomy and coronary artery bypass grafting (C-CABG) has been identified as having a high perioperative risk. Therefore, carotid artery stenting has been recommended. Missing level I evidence concerning C-CABG and carotid stenting have motivated us to review our experience over the past 5 years in C-CABG. Single centre retrospective study of 113 C-CABG was performed between January 2000 and December 2004. Mean age of the patients was 65 years (22 patients were 80 years old or older). Carotid endarterectomy was performed first in the same narcosis. Thirty day mortality was 4.4% (5/113), with no neurological death. Overall neurological complication rate was 3.5% (4/113) due to one stroke that resolved within 30 days and three TIA's. C-CABG, with carotid endarterectomy performed first, is a safe technique with a low stroke rate. The risky part of the C-CABG is not the carotid intervention itself, but the CABG procedure. Therefore, as long as single carotid artery stenting has not clearly shown early and/or long-term advantages over carotid endarterectomy, it does not seem to be justified in C-CABG.

    Key words: carotid artery, endarterectomy, coronary artery, bypass grafting