Coexistent Coronary and Cerebrovascular Disease: Results of Simultaneous Surgical Management in Specific Patient Groups

Objective: Results of synchronous combined revascularization were examined in specific patient groups with coexistent coronary and cerebrovascular diseases. Methods: Between 1.1.1980 and 31.12.1998, 408 patients underwent a synchronous combined carotid endarterectomy (CEA) + myocardial revascularization (CABG). In 259 (63.5%) patients, carotid disease was asymptomatic. Remaining patients presented with a previous stroke ( n = 35) or a transient ischemic episode (TIA) ( n = 114). In 245 (60%) patients, carotid stenosis was bilateral (Group A: bilateral ≥ 80% stenosis. Group B: contralateral occlusion, Group C: contralateral subcritical disease). A synchronous ipsilateral CEA + CABG was performed in all patients with an unilateral disease ( n = 163) and also in all Group B ( n = 33) and Group C ( n = 142) patients with bilateral disease. A simultaneous bilateral CEA + CABG was performed in 12 high risk Group A patients. Remaining Group A patients ( n = 58), initially underwent an ipsilateral CEA for most dominant lesion + CABG, soon followed by the contralateral CEA. Results were examined in above specific patient Groups. Results: Overall combined hospital mortality from stroke + myocardial infarction was 2.45%. No independent predictor of stroke was identified. In general, initial prophylactic CEA, subdued the risk of subsequent strokes for 7–8 yr. Predictors of a late stroke were: progression of bilateral ( P = 0.007) and intracranial ( P = 0.04) cerebrovascular disease. Highest risk of an early stroke was recorded in Group A patients. A composite high risk group of patients with multiple risk factors ( n = 155) demonstrated a higher risk of both early and late strokes, as compared to the remaining patients ( n = 253) ( P < 0.04). Observed risk of early and late strokes, in specific patient groups was lower than standard predictions. Conclusions: A regular use of combined approach was justified in the above patient groups.