title: Simultaneous carotid endarterectomy and coronary revascularization.
abstract: BACKGROUND
  Combined cardiac operation and carotid endarterectomy using our technique is an acceptable approach to simultaneous correction of both carotid and cardiac disease.
  
  
  METHODS
  From August 1989 to March 1998, 121 consecutive patients underwent combined operations. Of these patients, 112 had coronary artery bypass grafting and carotid endarterectomy, and 9 had coronary artery bypass grafting, carotid endarterectomy, and valve repair or replacement. All patients had a critical stenosis of 85% or more of the carotid artery. Mean age of the patients was 69.2 years; 80 patients were 65 years old or older. There were 88 men and 33 women. Notable risk factors included chronic obstructive pulmonary disease (19.8%), congestive heart failure (28%), preoperative myocardial infarction and unstable angina (66.9%). Of the patients, 20.7% had a stenosis of greater than 50% of the left main coronary artery. The technique used was correction of both the carotid and coronary lesions during a single aortic cross-clamp period using retrograde continuous blood cardioplegia for myocardial protection. Systemic hypothermia to 25 degrees C was used for cerebral protection.
  
  
  RESULTS
  Mean cross-clamp time was 118 minutes. Seven patients (5.8%) sustained perioperative cerebrovascular accidents. Two patients had transient ischemic attacks. The procedure-related mortality rate was 5.8%.
  
  
  CONCLUSIONS
  The described technique is a good method for simultaneous repair of coronary and carotid lesions in a high-risk group of patients with concomitant disease. We will continue to use it.
authors.affiliation: Main Line Cardiothoracic Surgeons, Lankenau Hospital, Wynnewood, Pennsylvania 19066, USA.
authors.forename: L
authors.initials: L
authors.lastname: Khaitan
authors.forename: F P
authors.initials: FP
authors.lastname: Sutter
authors.forename: S M
authors.initials: SM
authors.lastname: Goldman
authors.forename: T
authors.initials: T
authors.lastname: Chamogeorgakis
authors.forename: M A
authors.initials: MA
authors.lastname: Wertan
authors.forename: B P
authors.initials: BP
authors.lastname: Priest
authors.forename: J D
authors.initials: JD
authors.lastname: Whitlark
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D016893:Carotid Stenosis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome