Peripheral Vascular Surgery Society

Introduction: Data from 213 cases of simultaneous carotid endarterectomy and coronary artery bypass grafting (CEN/CAB) were analyzed (1980-96).

Methods: There were 154 males (72%) and 59 females (28%), with a mean age of 65 years (range: 42-83). Ninety-five patients (45%) had angina, 52 (24%) had myocardial infarction, and 23 (11%) had congestive heart failure. Symptomatic cerebrovascular disease was present in 89 patients (42%). One hundred and twenty-one patients (57%) had three-vessel coronary artery disease, 36 (17%) had left main disease, and 86 (40%) had a depressed ejection fraction (E.F.<50%). Significant (>75% diameter reduction ) stenosis was present in 168 (79%) of the operated carotid arteries and in 45 (21%) of the contralateral ones.

Results: The hospital mortality was 5.6% (12 patients). The cause of death was cardiac in 10 patients (4.6%), and neurologic in 2 (1%). Eleven patients (5.1%) developed a stroke postoperatively; 8 strokes were ipsilateral to the operated artery, and 6 were permanent. Myocardial infarction occurred in 5 patients (2.3%). Independent predictors of early mortality were age >62, hypertension, and postoperative stroke (p<0.05). Male sex was the only predictor of neurologic morbidity (p<0.05). Late follow-up data was obtained for 163 (77%) patients (mean: 46.6 months, range: 1-168). Three (7%) out of the 41 late deaths were attributed to strokes. There were 3 (1.8%) late ipsilateral strokes, and 4 (2.5%) contralateral strokes. Independent predictors of late mortality included age >62 years, and preoperative E.F. <50%. The 5- and 10-year survival probabilities were 75% ± 4%, and 53% ± 7%. The freedom from late ipsilateral stroke at 5 and 10 years were 98% ± 1% and 96% ± 2%, respectively.

Conclusions: Combined CAB/CEN can be performed with an acceptable perioperative morbidity and mortality. Excellent long-term freedom from stroke can be expected.