Combined carotid coronary reconstructions--synchronous or sequential?

Analysis of 16 synchronous with 26 sequential combined carotid coronary reconstructions showed no statistical advantage of either approach. Sequential operations are more convenient but increase the total operating time by an hour or so. Synchronous operations can be carried out without carotid shunting despite hypotension provided hypothermia is established. In other circumstances the internal carotid back pressure is used to indicate the need for carotid shunting. In the 42 patients there were three strokes (7%) including one fatal stroke (2%) and two myocardial infarctions, both fatal (5%).