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Abstract
The management of patients with combined carotid and coronary artery
disease remains controversial. Up to 28% of patients presenting for carotid
endarterectomy (CEA) have severe reconstructible coronary artery disease, and
up to 22% of patients presenting for coronary artery bypass grafting (CABG)
have severe carotid artery disease. Myocardial infarction is the most common
cause of early and late mortality after CEA. Stroke after CABG is a devastating
and dreaded complication. Duplex ultrasound testing prior to coronary
revascularization is recommended. The 3 options for treatment include the staged
approach (CEA followed by CABG), the reversed staged approach (CABG
followed by CEA), and the combined approach (CEA and CABG during the
same anesthetic). The result of each of these approaches varies widely and
primarily depends on patient selection. A policy of CEA prior to CABG is
justified only in patients with stable coronary disease, good ejection fraction, and
is best-performed using regional anesthesia. The combined approach is well
accepted in those patients with severe, symptomatic disease in both the carotid
and coronary artery disease. Off pump coronary revascularization has emerged as
a viable option in the treatment of coexisting clinically significant carotid and
coronary artery disease.
The main goal of this study is to compare the results of different surgical
approaches and to choose the best approach to treat combined carotid and
coronary artery disease and to minimize the incidence of complications such as
myocardial infarction, stroke, congestive heart failure, arrhythmias and others. 30
cases were in room in this study. 17 cases in stage approach. Complicated by 1
case myocardial infarction and 1 case by nerve dysfunction and 1 case mortality,
and 1 case hematoma, 6 cases in reserved staged approach and no complication
was done and 7 cases in combined approach and complicated by 1 case stroke
and 2 cases hematoma.