Abstract
We performed seven carotid endarterectomies (CEA) associated with ischemic heart disease. We classified the operative procedure into three groups according to symptoms: 1) CEA prior to A-C bypass (simultaneous operation), 2) Percutaneous transluminal coronary angioplasty (PTCA) prior to CEA, and 3) Separated operations. Group one comprised three cases, group two had one, and group three had three. CEAs were performed under administration of barbiturate with intraarterial shunt. There was no mortality or morbidity.
CEA was recommended for patients with previous neurological symptoms and appropriate bifurcation disease and for patients with asymptomatic carotid bruit caused by significant stenosis of the proximal ICA. Prophylactic CEA for the patient with an asymptomatic carotid bruit is controversial. On the other hand, neurological complications might be expected to occur in high frequency among patients with recognized carotid stenosis at the time of myocardial revascularization. Whether carotid and coronary arterial revascularization should be performed simultaneously or separately remains a controversial question. In asymptomatic patients, cerebral hypoperfusion in extra-corporeal circulation at the A-C bypass is a danger, and carotid vascular reconstruction must be performed before A-C bypass. In symptomatic patients, CEA without myocardial revascularization may be dangerous in impending anginal attack.
Our operative strategies are as follows: simultaneous CEA and myocardial revascularization are desirable for both symptomatic and asymptomatic carotid lesions. PTCA is suitable for coronary high-risk patients in the face of myocardial infarction intraoperatively. In separate onset of stroke, there are no problems for treatment of each disease.
