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Ann Thorac Surg 1988;45:574-581
© 1988 The Society of Thoracic Surgeons

Articles

Combined Carotid and Coronary Artery Surgery: A Review of the Literature

David C. Newman, F.R.A.C.S.*, Richard G. Hicks

From the Departments of Cardiothoracic Surgery and Neurology, the Prince Henry Hospital, Sydney, Australia

* Address reprint requests to Dr. Newman, Department of Cardiothoracic Surgery, The Prince Henry Hospital, P.O. Box 233, Matraville, N.S.W. 2036, Australia

This article reviews 41 different reports that describe various means of surgical management of coexistent carotid and coronary artery disease in almost 1,500 patients. Stroke is the major risk for patients undergoing myocardial revascularization in the presence of symptomatic carotid artery disease or an asymptomatic carotid bruit that reflects an ulcerative lesion or stenosis exceeding 75%. However, patients with asymptomatic carotid stenosis should not routinely undergo prophylactic carotid end-arterectomy. Myocardial infarction is the major hazard in patients undergoing carotid endarterectomy who have coronary artery disease. This risk is magnified when the disease is silent. A high level of awareness and rigorous screening are essential in all patients suspected of having coexistent disease. Although a protocol for the management of these patients is important, individual assessment is essential.




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