Education And Debate

A Difficult Case: Perform carotid endarterectomy and coronary artery bypass surgery as a single procedure

BMJ 1995; 310 doi: (Published 03 June 1995) Cite this as: BMJ 1995;310:1451
  1. Philip Hornick, BHF research fellow in cardiothoracic surgerya,
  2. K M Taylor, BHF professor of cardiac surgera
  1. a Department of Cardiothoracic Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London W12 0HS

    This patient has appreciable carotid and coronary artery disease. Surgical correction of one disorder in the presence of the other carries an associated risk of morbidity and death. As regards the carotid stenosis and the patient's neurological state, advocating surgery as opposed to a conservative policy has been verified by several prospective randomised trials.1 2

    The risk of myocardial infarction in patients having carotid endarterectomy is estimated as 18% in patients with stable angina.3 This patient has unstable angina and therefore we presume that the risk of perioperative myocardial infarction is greater. The risk of stroke in patients having coronary artery …

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