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Simultaneous Redo Carotid Endarterectomy and Coronary Artery Bypass

High-grade (>80%) internal carotid artery stenosis is a risk factor for stroke in patients undergoing coronary artery bypass grafting (CABG). Primary carotid endarterectomy (CE) is frequently and safely performed along with CABG to decrease the risk of perioperative stroke. Whether recurrent carotid stenosis is a risk factor for peri-CABG stroke, and whether combined reoperative carotid surgery and CABG is a higher risk procedure then primary endarterectomy and CABG, is unknown. Seven patients underwent recurrent carotid surgery along with coronary artery bypass (CAB). Five patients were asymptomatic, and two were symptomatic. Four patients underwent patch angioplasty alone and 3 patients underwent endarterectomy and patch angioplasty. Five patients underwent primary CAB and two patients redo CAB. There were no perioperative neurologic events, no episodes of cranial nerve injury, and no reoperations for bleeding. All patients survived the combined procedure and were discharged in 6.2 ±0.8 days. Combined redo CE and CAB can be safely performed in patients with high-grade recurrent carotid stenosis.