[Simultaneous surgical intervention for occlusion of the internal carotid artery and coronary disease--reasonable or high-risk combination?].
OBJECTIVE
Carotid artery stenosis as risk factor for postoperative stroke after cardiac surgery is confirmed in recent publications. Nevertheless indications for combined procedures in carotid occlusive disease and coronary artery disease are discussed controversely in the literature. Based on our own experiences since 1992 the risk factors are reviewed.


METHODS
The data of 104 patients (80 male, 24 female, age 67 +/- 7 years), with 106 combined operations performed between 1992 and 1999, were evaluated retrospectively. 36% of the patients had symptomatic and 64% had asymptomatic carotid artery stenosis.


RESULTS
Seven patients (6.6%) developed postoperative neurological deficits. One patient (1.0%) died as result of a stroke. In three patients a stroke occurred in the ipsilateral hemisphere, whereas two of three patients with cerebral infarction in the contralateral hemisphere had no significant carotid artery stenosis on this side. One patient had multiple bilateral embolism. Cardiac complications occurred in seven patients (6.6%). The inhospital mortality for non-stroke related complications was 3.8%, the total mortality 4.8%.


CONCLUSIONS
From our experiences the combined approach for carotid artery occlusive disease and coronary artery disease can be recommended in selected patients. The rate of complications seems to be lower than in staged procedures. The spontaneous course of the disease can be improved and the patient is spared a second operation.
Grabitz
K
K
Klinik für Gefässchirurgie und Nierentransplantation, Heinrich-Heine-Universität Düsseldorf.
Ommer
A
A
Schmitt
H H
HH
Gams
E
E
Sandmann
W
W
D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002544:Cerebral Infarction / Q000209:etiology; D003327:Coronary Disease / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome