The presence of significant multifocal vascular disease indicates an advanced stage of atherosclerosis. The coexistence of significant obstructive cerebrovascular disease or cervical carotid stenosis and coronary artery disease presents a difficult combination for surgical intervention.
With the aim of reducing the risk of perioperative cardiovascular events, we did a comparative analysis of preoperative cardiovascular conditions and surgical results. According to ACC/AHA Task Report (Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery), it is important to evaluate surgery-specific risk, clinical predictors of increased perioperative cardiovascular risk, and functional capacity.
When there are major predictors of clinical risk, cancellation or delay of surgery is advisable until the risk has been reduced. Patients with intermediate predictors of clinical risk and poor functional capacity have a likelihood of perioperative cardiac events as demonstrated with 2 of our cases. Patients with intermediate or minor predictors of clinical risk and moderate or excellent functional capacity can generally undergo surgery with little perioperative cardiac risk.
Patients will require a careful consideration of clinical, surgery-specific, and functional status before a decision can be made as to whether to proceed to surgical intervention.
