Simultaneous Surgery of Carotid Endarterectomy and Coronary Artery Bypass Graft

We review our 15 years of experience with patients with carotid artery stenosis to clarify the incidence of coronary artery disease. Of 197 patients who underwent carotid endarterectomy (CEA) since 1985, 16 (8.1%) had coronary artery disease that required treatment. Eleven patients could safely undergo staged treatments of CEA and coronary artery bypass graft (CABG)/percutaneous transluminal coronary angioplasty (PTCA). Four patients, however, underwent simultaneous CEA and CABG, because both carotid and coronary artery diseases were too serious for safe staged surgery. We present the detailed medical records of these 4 cases. All had tight (more than 90%) stenosis of the internal carotid artery (ICA) and 2 or 3 branches of the coronary artery. They experienced TIA or minor completed stroke as well as unstable angina. One patient also presented chronic heart failure due to severe myocardial ischemia. We performed CEA and then CABG. Would closure was done after all surgical procedures to avoid bleeding due to intraoperative heparinization. Postoperative courses were uneventful in all 4 patients. We performed carotid stenting preceding simultaneous surgery with contralateral CEA and CABG for 1 patient who had bilateral severe carotid stenosis.