title: Combined surgical approach for carotid and coronary stenosis. Sixty-four patients and review of literature.
abstract: BACKGROUND
  The proper role of combined carotid endarterectomy (CEA) and coronary bypass (CABG) is still controversial. We contribute to the discussion through the critical evaluation of 64 consecutive patients, whose data have been collected in a prospective way.
  
  
  METHODS
  Between 1990 and 1999, 64 patients presenting a critical coronary disease (unemendable by PTA) associated with severe carotid stenosis (= or >70% if symptomatic, = or >80% if asymptomatic), underwent combined CEA-CABG. Cardiological symptoms were evident in 90.6% of cases. Thirty-five patients (54.7%) had a three-vessel coronaropathy, 18 (28.1%) a two-vessel disease and 11 (17.2%) severe stenosis of the common trunk; furthermore 7 patients (10.9%) had a low ejection fraction (<50%). A positive neurologic history was present in 22 (44%) patients. Thirty-four patients (55%) had a carotid stenosis >90%; a significant disease of the contralateral carotid axis was observed in 53% of cases: stenosis >50% in 30 patients and thrombosis in 4. CEA was performed with somato-sensorial evoked potential monitoring.
  
  
  RESULTS
  The hospital mortality rate was 6.2% (4 patients). The cause of death was cardiac in 2 cases (1 early bypass thrombosis and 1 irreversible coronary spasm) and related to a multiorgan failure in 2. The neurologic morbidity rate was 0%.
  
  
  CONCLUSIONS
  Our data highlight that in these high-risk patients the combined approach dramatically reduces the stroke risk although the mortality rate is still higher than that observed after CEA or CABG.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Section, University of Brescia, Brescia, Italy. bonardel@master.cci.unibs.it
authors.forename: S
authors.initials: S
authors.lastname: Bonardelli
authors.forename: N
authors.initials: N
authors.lastname: Portolani
authors.forename: G A M
authors.initials: GA
authors.lastname: Tiberio
authors.forename: F
authors.initials: F
authors.lastname: Nodari
authors.forename: M
authors.initials: M
authors.lastname: De Lucia
authors.forename: G
authors.initials: G
authors.lastname: Quartierini
authors.forename: R
authors.initials: R
authors.lastname: Maffeis
authors.forename: G
authors.initials: G
authors.lastname: Ghilardi
authors.forename: R
authors.initials: R
authors.lastname: Lorusso
authors.forename: C
authors.initials: C
authors.lastname: Latini
authors.forename: M
authors.initials: M
authors.lastname: Zogno
authors.forename: S M
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies