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The Journal of Cardiovascular Surgery 2002 June;43(3):385-90

language: English

Combined surgical approach for carotid and coronary stenosis. Sixty-four patients and review of literature

Bonardelli S., Portolani N., Tiberio G. A. M., Nodari F., De Lucia M., Quartierini G., Maffeis R., Ghilardi G., Lorusso R. *, Latini C., Zogno M. *, Giulini S. M.

From ­the Department of Medical ­and Surgical Sciences Surgical Section University of Brescia
*Cardiothoracic Surgery of Spedali Civili Hospital, Brescia, Italy


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Background. The prop­er ­role of com­bined carot­id endar­te­rec­to­my (­CEA) ­and cor­o­nary ­bypass (­CABG) is ­still con­tro­ver­sial. We con­trib­ute to ­the dis­cus­sion ­through ­the crit­i­cal eval­u­a­tion of 64 con­sec­u­tive ­patients, ­whose ­data ­have ­been col­lect­ed in a pros­pec­tive ­way.
Methods. Between 1990 ­and 1999, 64 ­patients pre­sent­ing a crit­i­cal cor­o­nary dis­ease (unemend­able by ­PTA) asso­ciat­ed ­with ­severe carot­id sten­o­sis (≥70% if symp­to­mat­ic, ≥80% if asymp­to­mat­ic), under­went com­bined ­CEA-­CABG. Cardiological symp­toms ­were evi­dent in 90.6% of cas­es. Therty-­five ­patients (54.7%) ­had a ­three-ves­sel coron­a­rop­a­thy, 18 (28.1%) a ­two-ves­sel dis­ease ­and 11 (17.2%) ­severe sten­o­sis of ­the com­mon ­trunk; fur­ther­more 7 ­patients (10.9%) ­had a ­low ejec­tion frac­tion (<50%). A pos­i­tive neu­ro­log­ic his­to­ry ­was ­present in 22 (44%) ­patients. Thirty-­four ­patients (55%) ­had a carot­id sten­o­sis >90%; a sig­nif­i­cant dis­ease of ­the con­tralat­er­al carot­id ­axis ­was ­observed in 53% of cas­es: sten­o­sis >50% in 30 ­patients ­and throm­bo­sis in 4. ­CEA ­was per­formed ­with soma­to-sen­so­ri­al ­evoked poten­tial mon­i­tor­ing.
Results. The hos­pi­tal mor­tal­ity ­rate ­was 6.2% (4 ­patients). The ­cause of ­death ­was car­diac in 2 cas­es (1 ear­ly ­bypass throm­bo­sis ­and 1 irre­ver­sible cor­o­nary ­spasm) ­and relat­ed to a mul­ti­or­gan fail­ure in 2. The neu­ro­log­ic mor­bid­ity ­rate ­was 0%.
Conclusions. Our ­data high­light ­that in ­these ­high-­risk ­patients ­the com­bined ­approach dra­mat­i­cal­ly reduc­es ­the ­stroke ­risk ­although ­the mor­tal­ity ­rate is ­still high­er ­than ­that ­observed ­after ­CEA or ­CABG.

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