The Efficacy of Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting

Abstract

The purpose of this study was to evaluate the efficacy of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Between April 2006 and April 2014, a total of 57 patients with carotid artery stenosis underwent CEA in our institution. Among them, 7 patients (12.3%; 5 males, 2 females; mean age 74.9 ± 4.5 years) with significant coronary artery disease underwent combined CEA and CABG. Three patients had symptomatic stenosis, with mean degree of stenosis of 71 ± 20% according to the North American Symptomatic Carotid Endarterectomy Trial method. Although one patient (14%) developed postoperative recurrent nerve paralysis, and another patient (14%) died due to postoperative intra-thoracic hemorrhage, technical success had been obtained in all 7 patients without any peri-operative neurological or cardiac complications. It is well known that 30% to 40% of patients with carotid stenosis have coronary artery disease. When CABG is performed in cases of significant carotid stenosis, the risk of perioperative stroke increases. One of the approaches to solve this problem is combined CEA and CABG. Though it might a need longer time for surgery and carries a higher risk of surgical bleeding compared with a single surgery, it can decrease both neurological and cardiac ischemic complications. In our experience, combined CEA and CABG is a preferred surgical approach for high-risk patients.