Management of symptomatic bilateral severe carotid artery and coronary artery disease

Background: This study aims to investigate the safety and effectiveness of closely sequential carotid endarterectomy and synchronous cardiac surgery in patients with symptomatic bilateral severe carotid artery and coronary artery disease. Methods: The study included 12 consecutive patients (7 males, 5 females; mean age 70.3 +/- 5.1 years; range 61 to 78 years) who were performed closely sequential carotid endarterectomy and synchronous cardiac surgery in our clinic between September 2010 and January 2014. All patients were neurologically symptomatic: five patients (41.7%) had transient ischemic attack, two patients (16.7%) had reversible ischemic neurologic deficit, one patient (8.3%) had amaurosis fugax, one patient (8.3%) had stroke with sequel, and three patients (25%) had stroke without sequel. Also, severe bilateral carotid stenosis was detected in all patients. When indication for carotid endarterectomy was identified, the degree of stenosis, plaque morphology or both were considered. Patients' plaque characteristics were described according to ultrasonographic Gray-Weale plaque type characterization. Cardiopulmonary perfusion was used in all cardiac surgeries. Mean follow-up period was 12.2 +/- 9.6 months (range 0 to 32 months). Results: One patient died on the postoperative fourth day due to low cardiac output state and multi-organ failure. Unilateral laryngeal nerve damage occurred in one patient. Mean carotid occlusion time (at symptomatic and asymptomatic side), aortic cross-clamping time and cardiopulmonary perfusion time were 16.3 +/- 3.5 minutes (range 8 to 22 minutes) (at symptomatic side), 17.0 +/- 3.9 minutes (range 7 to 23 minutes) (at asymptomatic side), 63 14 minutes (range 38 to 84 minutes) and 79 19 minutes (range 50 to 120 minutes), respectively. Mean duration of stay in cardiac care unit was 3 +/- 0.9 days and total hospital stay duration was 13.5 +/- 2.7 days. Mean waiting duration for closely sequential surgery was 5.2 +/- 1.3 days (range 3 to 7 days). No cardiovascular event was observed during the follow-up period. Conclusion: According to our study results, closely sequential carotid endarterectomy and synchronous cardiac surgery may be a safe and effective method in patients with symptomatic bilateral severe carotid artery stenosis accompanied with cardiac pathology.