title: Comparison of Early Outcomes with Three Approaches for Combined Coronary Revascularization and Carotid Endarterectomy.
abstract: This study aims to compare three different surgical approaches for combined coronary and carotid artery stenosis as a single stage procedure and to assess effect of operative strategy on mortality and neurological complications.
  
  
  
  This retrospective study involves 136 patients who had synchronous coronary artery revascularization and carotid endarterectomy in our institution, between January 2002 and December 2012. Patients were divided into 3 groups according to the surgical technique used. Group I included 70 patients who had carotid endarterectomy, followed by coronary revascularization with on-pump technique, group II included 29 patients who had carotid endarterectomy, followed by coronary revascularization with off-pump technique, group III included 37 patients who had coronary revascularization with on-pump technique followed by carotid endarterectomy under aortic cross-clamp and systemic hypothermia (22-27ºC). Postoperative outcomes were evaluated.
  
  
  
  Overall early mortality and stroke rate was 5.1% for both. There were 3 (4.3%) deaths in group I, 2 (6.9%) deaths in group II and 2 (5.4%) deaths in group III. Stroke was observed in 5 (7.1%) patients in group I and 2 (6.9%) in group II. Stroke was not observed in group III. No statistically significant difference was observed for mortality and stroke rates among the groups.
  
  
  
  We identified no significant difference in mortality or neurologic complications among three approaches for synchronous surgery for coronary and carotid disease. Therefore it is impossible to conclude that a single principle might be adapted into standard practice. Patient specific risk factors and clinical conditions might be important in determining the surgical tecnnique.
authors.affiliation: Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital Istanbul, Turkey.
authors.forename: Arzu Antal
authors.initials: AA
authors.lastname: Dönmez
authors.affiliation: Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital Istanbul, Turkey.
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.affiliation: Sakarya University Training and Research Hospital Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Sacli
authors.affiliation: Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital Istanbul, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Koksal
authors.affiliation: Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital Istanbul, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Alp
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome