The safety of carotid endarterectomy at the time of coronary artery bypass surgery: Analysis of results in a high-risk patient population

From Jan. 1, 1979, to Dec. 31, 1983, 37 patients have undergone simultaneous carotid endarterectomy and myocardial revascularization. There were 27 men and 10 women, and their ages ranged from 45 to 74 years (mean 61.3 years). Unstable angina was present in 61%, significant stenosis in the left main coronary artery in 27%, and either unstable angina or disease of the left main coronary artery in 70% of these patients. All patients had hemodynamically significant stenosis of the carotid artery on the operated side and 14 patients (38%) had bilaterally significant disease; three patients (8%) had a contralateral total occlusion of the carotid artery. There were no deaths resulting from neurologic factors, no permanent, and only one transient (2.7%) neurologic deficits. There were three deaths from cardiac causes (8.1%). Carotid endarterectomy may be performed safely at the time of myocardial revascularization in a patient population with a high incidence of unstable angina and disease of the left main coronary artery. The evolution of and rationale for the combined surgical approach to coexistent carotid and coronary artery disease is discussed and the literature reviewed.