Coexistent coronary and cerebrovascular disease: results of simultaneous surgical management in specific patient groups.
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.
Kaul
T K
TK
Department of Cardiac Surgery, Baptist Medical Center, 817 Princeton Avenue SW, AL 35211, Birmingham, USA.
Fields
B L
BL
Riggins
L S
LS
Wyatt
D A
DA
Jones
C R
CR
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