[Carotid endarterectomy in patients with coronary heart disease].
BACKGROUND
Patients with coexistent coronary and carotid artery disease are at high risk of developing stroke following coronary artery bypass grafting (CABG) and at the same time at increased risk of myocardial infarction when subjected to carotid endarterectomy (CEA). In patients with pronounced symptoms from both vascular territories, some institutions advocate a combined approach, with both CABG and CEA performed during the same period of anaesthesia.


METHODS
We reviewed the medical records of patients who underwent the combined procedure between 1986 and 2004 (n = 37; group 1) and compared them to patients with coronary artery disease who underwent isolated CEA over the same period of time (n = 118; group 2).


RESULTS
The ASA score, NYHA class, prevalence of peripheral artery disease, atrial fibrillation and contralateral carotid occlusion were significantly higher in group 1. Two patients (5.4%) in group 1 and five patients (4.2%) in group 2 suffered a stroke. Five of these were ipsilateral to the CEA. Six patients had a perioperative myocardial infarction, one in group 1 (2.7%) and five (4.2%) in group 2 (ns). There were no deaths in group 1 and three deaths (2.5%) in group 2 during the first 30 days after surgery. The cumulative risk of death, stroke and myocardial infarction within 30 days was 8.1% in group 1 and 11.0% in group 2.


CONCLUSIONS
Patients with coexistent atherosclerosis of the coronary and carotid arteries who underwent the combined procedure seem to have the same perioperative risk as patients with coronary artery disease who underwent isolated CEA, in spite of the fact that the former had a more generalised atherosclerotic disease.
Aarsaether
Erling
E
Avdeling for hjerte-/lunge- og karkirurgi, Universitetssykehuset Nord-Norge, 9038 Tromsø. erling.johan.aarsaether@unn.no
Moe
Øystein K
ØK
Dahl
Per Erling
PE
Busund
Rolf
R
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology