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The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 7-16, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
EL Jones, JM Craver, RA Michalik, DA Murphy, RA Guyton, DK Bone, CR Hatcher and NA Reichwald
Three groups of patients were analyzed to ascertain the risk of combined
carotid/coronary operations and the risk factors for perioperative stroke
following coronary artery bypass (CAB). Group 1 (N = 132) had simultaneous
carotid endarterectomy and CAB, Group 2 (N = 51) were patients having
perioperative stroke following elective CAB, and Group 3 (N = 169) had CAB
alone but had prior history of either asymptomatic cervical bruit,
stroke/transient cerebral ischemic attack (TIA), or carotid endarterectomy.
Hospital mortality and perioperative stroke rate in the combined
carotid/coronary group were 3.0% (4/132) and 1.6% (2/126), respectively.
These rates were not significantly different from those of a control group
having CAB alone. Overall incidence of postoperative stroke in 5,676
patients having CAB alone was 0.9% (51 patients). The incidence of
perioperative stroke in patients with asymptomatic bruit or prior history
of stroke or TIA undergoing CAB alone was 3.3% (2/60) and 8.6% (6/70),
respectively. The majority of strokes following CAB appear to be embolic in
origin. Indications for simultaneous carotid/coronary operations are
bilateral carotid disease and symptomatic carotid vascular disease
associated with unstable angina, left main obstruction, or diffuse
multivessel disease. Staged procedures are recommended for patients with
stable angina and symptomatic carotid lesions and for difficult carotid
revascularization procedures. CAB alone may be performed for most patients
with asymptomatic cervical bruit, moderate or mild carotid artery
obstruction, and unstable angina associated with prior stroke, although in
the third situation postoperative risk of neurological injury may be
increased.
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