Combined coronary artery bypass and carotid endarterectomy: long-term results.

PURPOSE: We determined late survival, freedom from late stroke, and freedom from late cardiac events in patients treated by combined coronary artery bypass and carotid endarterectomy (CAB/CEA).
METHODS: All patients who underwent CAB/CEA in our institution between January 1994 and December 1999 were identified. Follow-up data were obtained from office records and telephone interviews. Endpoints included death from any cause, stroke, and non-fatal cardiac events (MI, CHF, percutaneous transluminal angioplasty with stenting, redo CAB). Data were expressed in life table format.
RESULTS: Over a 6-yr period 154 patients had combined CAB/CEA with a 3.9% postoperative stroke rate. Six patients (3.9%) died, leaving 148 patients for follow-up. Average follow-up was 38 +/- 23 months (range: 1-82 months). During the follow-up period two patients (1.4%) had late strokes and 17 patients (11%) had late non-fatal cardiac events. The late mortality rate was 13% (19 patients). Of the late mortalities, four were related to cardiac disease and one to stroke. Using Kaplan-Meier analysis, the 5-yr survival probability was 80 +/- 4.3%. The freedom from late ipsilateral neurologic events was 98 +/- 1.3% at 5 yr. The freedom from late cardiac events was 82 +/- 4.6% at 5 yr.
CONCLUSIONS: The large majority of patients with combined coronary and carotid artery disease can be expected to live for greater than 5 yr. Therefore, these patients should be considered candidates for prophylactic CEA for stroke prevention, even when their carotid lesions are asymptomatic. Successful CAB/CEA provides good long-term survival and freedom from late cardiac events, as well as excellent freedom from late stroke. Further reduction in perioperative events will make this operative approach even more attractive in patients with combined disease.