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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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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