Simultaneous Carotid Endarterectomy and Coronary Revascularization: Indications and Results


Authors: V. Přibáň;  J. Fiedler *;  V. Chlouba;  A. Mokráček 1;  M. Šetina 2
Authors‘ workplace: Neurochirurgické oddělení, Nemocnice České Budějovice a. s., primář MUDr. V. Chlouba ;  Neurochirurgická klinika LF MU a FN Brno *;  Kardiochirurgické oddělení, Nemocnice České Budějovice a. s. 1;  Kardiochirurgická klinika 2. LF UK a FN v Praze-Motole 2
Published in: Rozhl. Chir., 2011, roč. 90, č. 1, s. 67-72.
Category: Monothematic special - Original

Overview

Aim:
Evaluation of operative results and complications in high-risk patients who underwent combined carotid and coronary revascularization.

Patients and Methods:
Combined operation – carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) was performed in the period 2000–2009 in 68 patients. Simultaneous operation was indicated in patients with unstable angina pectoris and l. symtomatic internal carotid artery (ICA) stenosis ≥ 50%, or 2. bilateral asymptomatic ICA stenosis ≥ 60% or 3. asymptomatic ICA stenosis ≥ 60% combined with contralateral ICA occlusion. Combined operations represented 5.8% of whole CEA series. Mean age was 69.9 (51–82) years, men were 46, women 22.

Carotid angiography proved unilateral (always symptomatic) ICA stenosis in 25 patients, bilateral ICA stenosis in 35 patients and ICA stenosis combined with contralateral carotid occlusion in 8 patients. Neurological preoperative symptomatology: TIA was present in u 20 patients, minor stroke in 6 and major stroke in 5 patients. 37 patients were asymptomatic. One CABG was performend in 5 patients, 2 CABG in 20 patients, 3 CABG in 19 patients and 4 CABG in 6 patients. The rest of 18 patients had CABG operation combined with valve procedure. Comorbidity: hypertension 100%, diabetes mellitus 57.3%, hyperlipidemia 60.3%.

Shunt was selectively used in 4.4%. The need for shunt was established using back stump pressure and near infrared spectroscopy.

Results:
Mortality was 8.8% (6/68). The cause of death were multiorgan failure in two cases, ipsilateral stroke in two patients, respiratory insufficiency and cardiac failure due to graft occlusion both in one patient. Good recovery was recorded in 91.2%.

Conclusion:
Combined carotid and coronary revascularization has acceptable neurological morbidity/mortality in high risk patients. Strict requirement is thorough selection of patients.

Key words:
carotid endarterectomy – coronary bypass – simultaneous operations – stroke


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Surgery Orthopaedics Trauma surgery

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