title: Coexistent coronary and cerebrovascular disease: results of simultaneous surgical management in specific patient groups.
abstract: OBJECTIVE
  Results of synchronous combined revascularization were examined in specific patient groups with coexistent coronary and cerebrovascular diseases.
  
  
  METHODS
  Between 1.1.1980 and 31.12.1998, 408 patients underwent a synchronous combined carotid endarterectomy (CEA)+myocardial revascularization (CABG). In 259 (63.5%) patients, carotid disease was asymptomatic. Remaining patients presented with a previous stroke (n=35) or a transient ischemic episode (TIA) (n=114). In 245 (60%) patients, carotid stenosis was bilateral (Group A: bilateral > or =80% stenosis, Group B: contralateral occlusion, Group C: contralateral subcritical disease). A synchronous ipsilateral CEA+CABG was performed in all patients with an unilateral disease (n=163) and also in all Group B (n=33) and Group C (n=142) patients with bilateral disease. A simultaneous bilateral CEA+CABG was performed in 12 high risk Group A patients. Remaining Group A patients (n=58), initially underwent an ipsilateral CEA for most dominant lesion+CABG, soon followed by the contralateral CEA. Results were examined in above specific patient Groups.
  
  
  RESULTS
  Overall combined hospital mortality from stroke+myocardial infarction was 2.45%. No independent predictor of stroke was identified. In general, initial prophylactic CEA, subdued the risk of subsequent strokes for 7-8yr. Predictors of a late stroke were: progression of bilateral (P=0.007) and intracranial (P=0.04) cerebrovascular disease. Highest risk of an early stroke was recorded in Group A patients. A composite high risk group of patients with multiple risk factors (n=155) demonstrated a higher risk of both early and late strokes, as compared to the remaining patients (n=253) (P<0.04). Observed risk of early and late strokes, in specific patient groups was lower than standard predictions.
  
  
  CONCLUSIONS
  A regular use of combined approach was justified in the above patient groups.
authors.affiliation: Department of Cardiac Surgery, Baptist Medical Center, 817 Princeton Avenue SW, AL 35211, Birmingham, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Kaul
authors.forename: B L
authors.initials: BL
authors.lastname: Fields
authors.forename: L S
authors.initials: LS
authors.lastname: Riggins
authors.forename: D A
authors.initials: DA
authors.lastname: Wyatt
authors.forename: C R
authors.initials: CR
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000601:surgery*; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery; D002533:Cerebral Angiography; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology* / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors