TREATMENT OF ASSOCIATED CAROTID AND CORONARY DISEASE

Aim: The management of patients with combined carotid and coronary artery disease is controversial. Myocardial infarction is the most common cause of early and late mortality after carotid endarterectomy (CEA), and stroke after coronary artery bypass grafting (CABG) is a devastating and dreaded complication. This study aims to address different treatment strategies in patients with combined diseases. Methods: Thirty five patients with combined carotid artery stenosis and coronary artery disease were included in this case series. All patients were candidates for CABG, and their carotid status was either symptomatic or asymptomatic with critical stenosis. CEA either preceded CABG (the staged procedure) in 22 cases, was done in conjunction with CABG (the combined procedure)in 8 cases, orfollowed CABG (the reversed staged procedure) in 5 cases. Results: The mean age of study population was 71 ±7.0 years. Five patients (14.2%) had suffered a previous stroke. The study had a single mortality (2.85%; cardiac in origin), one myocardial infraction, and 2 cerebrovascular strokes (5.7%). Two patients suffered temporary 12th nerve dysfunction. Conclusion: Patients with severe, symptomatic disease in both the carotid and coronary artery territories probably benefit from a combined revascularization. In patients with stable disease in one of the vascular territories, the choice of a staged, combined, or reversed staged procedure is more controversial