Simultaneous myocardial revascularization and carotid endarterectomy.

Two methods for performing simultaneous carotid endarterectomy and coronary artery bypass grafting (CABG) were compared in 73 patients. A technique for performing carotid endarterectomy during cardiopulmonary bypass providing hypothermic cerebral protection was used in 37 patients (group 1). The 36 other patients (group 2) underwent carotid endarterectomy immediately before cardiopulmonary bypass was instituted. The mean age, New York Heart Association functional class, ventricular function and extent of carotid disease were similar in the two groups. The proportion of patients with previous myocardial infarction or stroke was higher in group 1 (p less than 0.05). One permanent neurologic deficit (technical error) and one transient neurologic deficit occurred in group 1 and none in group 2 (NS). Twenty-seven patients (37%) had left main disease, compared with an institutional incidence of 14.2% for all coronary operations. Five of seven patients who died early (three in group 1 and four in group 2) had left main disease. No advantage of one method over the other could be demonstrated. Patients with left main coronary artery disease and carotid disease have an increased operative risk.