title: [Appropriateness of simultaneous carotid endarterectomy and coronary revascularization].
abstract: BACKGROUND
  The presence of significant carotid artery disease in patients undergoing coronary artery bypass grafting has been reported to be as high as 17%. The optimal management of patients with significant coronary and carotid artery disease remains controversial. In this study, we analyze our recent experience with patients who underwent synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting.
  
  
  METHODS
  We reviewed the early outcome of 68 patients (56 males, 12 females, mean age 71.1 years, range 53-88 years) who underwent simultaneous CEA and coronary artery revascularization between January 2005 and June 2007. The frequency of unstable or ulcerated plaques was determined in symptomatic and asymptomatic patients.
  
  
  RESULTS
  Death for myocardial infarction occurred in 3 patients (4.4%). Stroke was found in 1 patient (1.4%). Combined 30-day stroke/mortality rate was 5.8%. The frequency of unstable or ulcerated plaques was 60.3% (41/68). An unstable stenosis was present in 23 out of 42 asymptomatic patients (54.7%).
  
  
  CONCLUSIONS
  Patients suffering from a concomitant coronary and carotid artery occlusive disease represent a high-risk population whose management is still controversial. A modern approach to combined CEA and coronary artery bypass grafting may be safe. The high frequency of unstable carotid lesions in asymptomatic patients suggests to treat every stenosis > 75% in candidates to coronary artery bypass grafting. Carotid artery stenting should be avoided in the majority of cases, considering the possibility of unstable carotid stenosis and the atherosclerotic involvement of aortic arch.
authors.affiliation: U.O. di Chirurgia Vascolare, European Hospital Via Portuense, 700 00149 Roma E-mail: raoulborioni@alice. it U.O. di Chirurgia Vascolare, Aurelia Hospital, Roma. raoulborioni@alice.it
authors.forename: Raoul
authors.initials: R
authors.lastname: Borioni
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Luca
authors.initials: L
authors.lastname: Welter
authors.forename: Laura
authors.initials: L
authors.lastname: Fratticci
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Caprara
authors.forename: Paolo
authors.initials: P
authors.lastname: Albano
authors.forename: Mariano
authors.initials: M
authors.lastname: Garofalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003331:Coronary Vessels / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome