title: Importance of strict patient selection criteria for combined carotid endarterectomy and coronary artery bypass grafting.
abstract: BACKGROUND
  Management of patients with severe concomitant carotid and coronary disease remains controversial. We report our experience of combined carotid endarterectomy (CEA) and coronary artery bypass surgery (CABG) over a fifteen year period using strict patient selection criteria.
  
  
  METHODS
  From 1st January 1995 to December 31st 2009 165 patients underwent combined CABG/CEA procedures at the Mater Hospital. Mean age was 68.2 years (range 43-88) and 127 (77%) were male. Fifty-three (32%) had symptomatic carotid disease. Indications for combined procedures were the presence of symptomatic >70% or asymptomatic >80% internal carotid artery stenosis in a patient requiring urgent CABG because of either unstable angina, recent MI, severe triple vessel disease or severe Left Anterior Descending or Left Main Stem stenosis.
  
  
  RESULTS
  Thirty-day stroke and death rate was 3%. All neurological events were in the hemisphere contralateral to the carotid surgery and symptoms had completely resolved prior to discharge from hospital. One patient required evacuation of a cervical haematoma and there were two transient XII nerve palsies.
  
  
  CONCLUSIONS
  Combined CEA/CABG can be performed safely with acceptable morbidity and mortality in patients selected in accordance with strict criteria in a centre with a large experience of both cardiac and carotid surgery.
authors: Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. mrcomcdonnell@gmail.com
authors: Ciarán O
authors: CO
authors: McDonnell
authors: Caroline C
authors: CC
authors: Herron
authors: John P
authors: JP
authors: Hurley
authors: James F
authors: JF
authors: McCarthy
authors: Lars
authors: L
authors: Nolke
authors: J Mark
authors: JM
authors: Redmond
authors: Alfred E
authors: AE
authors: Wood
authors: Martin K
authors: MK
authors: O'Donohoe
authors: M Kevin
authors: MK
authors: O' Malley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome