Management of coexistent carotid and coronary artery occlusive atherosclerosis

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Coexistent carotid and coronary artery disease is being recognized with increasing frequency in patients with symptoms primarily referable to one or occasionally both of these systems. This has posed a difficult question as to which surgical approach will minimize the risk of stroke or myocardial infarction in these sick patients.

We have, therefore, reviewed the clinical course of 92 consecutive patients in whom surgically treatable carotid and coronary arterial lesions had been diagnosed angiographically prior to surgical treatment of either system. There were 68 men and 24 women with a mean age of 59 years, range 38 to 78 years.

The preoperative status of these patients is shown in Table 1. In general, these patients were about 9 years older and had somewhat more severe coronary arterial disease than the overall group of patients undergoing coronary artery bypass from which they were derived. On the other hand, while the majority of patients had symptoms referable to their carotid lesion, over 40% (37/92) had asymptomatic bruits. Several bilateral carotid lesions were present in 16% (14/92) of the patients.

In 44 patients carotid endarterectomy and coronary bypass were performed simultaneously (Group I). In 35 patients, carotid endarterectomy was performed first and coronary bypass planned as a later procedure (Group II). Coronary bypass was performed first in 13 patients with carotid endarterectomy planned as a later procedure (Group III).

As Table 2 indicates, the best results were obtained in Group I with a 4.5% operative mortality and no permanent neurologic deficits. The worst . . .



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