A planned approach to coexistent cerebrovascular disease in coronary artery bypass candidates.

Of a series of 874 consecutive candidates for coronary artery bypass screened for cerebrovascular disease, 49 (5.6%) were found to have significant extracarnial lesions. Combined surgical management of both carotid and coronary artery lesions was then undertaken, using a planned approach based on clinical and angiographic criteria. Cerebrovascular reconstruction was undertaken prior to establishment of cardiopulmonary bypass, utilizing staged procedures in good-risk and simultaneous reconstruction in poor-risk candidates. Our experience indicates that combined surgical treatment of the patient with unilateral carotid obstruction and coronary disease is attended by no greater risk than that attached to coronary revascularization alone. The coronary bypass candidate with bilateral carotid artery disease represents a more advanced clinicopathological state whose treatment is attended by greater risk of operative morbidity and mortality.