ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Simultaneous carotid endarterectomy and coronary revascularization using moderate hypothermia in patients with bilateral carotid disease and coronary artery disease
Ercan Eren, Mehmet Balkanay, Mehmet Erdem Toker, Altuğ Tuncer, Cüneyt Keleş, Berk Özkaynak, Mustafa Güler, Gökhan İpek
Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, İstanbul
Background: The appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. This study was designed to investigate the safety and effectiveness of simultaneous applications of coronary revascularization and carotid endarterectomy under systemic hypothermia.

Methods: We retrospectively evaluated 15 patients (11 males, 4 females; mean age 64 years; range 55 to 72 years) with coronary artery disease and bilateral carotid artery stenosis. Nine patients had bilateral carotid artery disease with more than or equal to 70% stenosis and contralateral occlusion, and six patients had bilateral stenosis ranging between 80% and 99%. All the patients underwent carotid endarterectomy under moderate (25 ºC) systemic hypothermia. Coronary revascularization was performed during the periods of cooling and rewarming. The mean follow-up period was 26.2±8.3 months (range 12 to 41 months).

Results: No hospital mortality was seen. The mean number of grafts used was 2.7±0.7. The mean times of carotid occlusion and cross-clamping were 14.5±0.7 minutes and 104±8.2 minutes, respectively. The mean hospital stay was 7.6±0.8 days. None of the patients developed stroke or death or required contralateral carotid endarterectomy during the follow- up period.

Conclusion: Simultaneous coronary artery bypass grafting and carotid endarterectomy using moderate systemic hypothermia for cerebral protection is a safe and effective procedure for patients with coexisting coronary artery disease and significant bilateral carotid artery occlusive disease.

Keywords : Combined modality therapy; coronary artery bypass/methods; endarterectomy, carotid/methods
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