Myocardial Revascularization and Carotid Endarterectomy: a Combined Approach

The approach to the patient with combined carotid and coronary artery occlusive disease has been evolving since coronary bypass procedures became feasible. When neurological and cardiac symptoms are remote, sequential procedures are adequate. Neurological symptoms or severe carotid stenoses (or both) appearing simultaneously with symptoms of myocardial ischemia present a more difficult problem. Simultaneous operation has been performed in 16 patients with 1 early death (low output) and 2 cerebral complications (1 patient with residual hand weakness and 1 without neurological residua). The morbidity and mortality seemed unrelated to the fact that procedures were done at one operation. Therapy, however, must be tailored to the individual patient.