Combined Carotid Endarterectomy and Coronary Artery Bypass: a Still-Feasible Procedure?

To the Editor:The recent article by Randall et al1 is of great interest and involves a large number of patients undergoing carotid artery stent (CAS) and staged myocardial revascularization with a low incidence of periprocedural neurological complication. However, we have some comments and report our own experience.Regarding the AHA guidelines, we do not feel it appropriate to perform carotid/coronary surgery, as Naylor pointed out, with a staged procedure.2 Data on staged procedures taken from his meta-analysis are biased in that the authors do not indicate the number of patients initially enrolled and then submitted to the first procedure (carotid endarterectomy), and the number of patients who leave the study because of neurological or cardiac complications that would contraindicate the programmed staged heart surgery. Furthermore, any procedure, programmed or not, that leaves up to 6 months …