Simultaneous carotid and coronary arteries disease: staged or combined surgical approach?
BACKGROUND
Patients suffering from a concomitant coronary and carotid artery occlusive disease represent a high-risk population whose management remains controversial.


METHODS
Between April 1979 and June 2002, 202 patients (163 men and 39 women, mean age 65 +/- 7 years) were admitted at the Department of Cardiovascular Surgery of the University of Bologna for coronary artery bypass graft and carotid endarterectomy (CEA). In Group 1 (140 patients) coronary artery bypass graft and carotid endarterectomy were performed simultaneously while in Group 2 (62 patients) they were performed as two-staged procedures.


RESULTS
The rate of postoperative stroke was 6.4% in Group 1 (9/140) and 4.8% in Group 2 (3/62). Significant univariate predictors of myocardial infarction were smoking history and previous myocardial infarction; for stroke they were older, greater than 70 years, and a smoking history; for death the significant predictors were the operative approach, the low ejection fraction, smoking history, renal failure, and peripheral vascular occlusive disease. The hospital mortality was 6.4% in Group 1 versus 12.9% in Group 2.


CONCLUSIONS
Despite the highly selected populations, the contemporary surgical results indicate that the management of these patients needs careful pre-, intra-, and postoperative assessment and timing aimed at reducing the ischemic injuries, both cerebral and cardiac, therefore we believe that the surgical technique should be individualized for each patient.
Chiappini
Bruno
B
Department of Cardiovascular Surgery, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
Dell' Amore
Andrea
A
Di Marco
Luca
L
Di Bartolomeo
Roberto
R
Marinelli
Giuseppe
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis