[Surgical management of concomitant diseases of coronary and cerebral arteries--indication and late results].

Among 632 patients with isolated coronary artery bypass graftings (CABG), 77 patients had coexisting symptomatic or asymptomatic cerebrovascular diseases (group A). The other 555 patients had not concomitant cerebrovascular diseases (group B). Surgical and late mortality rate in group A and group B were 7.8%, 5.2%, and 6.4%, 3.6%, respectively. The late mortality rate in group A was significantly higher than those in group B. The cerebrovascular accident (CVA) rate in group A and group B were 5.2% and 1.3% in perioperative period, and 18.2% and 3.6% in late stage, respectively. The complication ratio of CVA after CABG were significantly higher in group A than those in groups B. In conclusion, the best surgical approach to the patients with combined coronary artery and cerebrovascular diseases who indicated CABG and extracranial to intracranial bypass graftinges (ECICG) were suggested as follows: 1) CABG is the first staged operation, if cerebrovascular disease is clinically stable. 2) ECICG for cerebrovascular disease is the first staged operation, if angina pectoris is clinically stable. 3) ECICG should be started in the first stage under the assist with IABP if both diseases in the crisis, and wait few days to perform CABG in the second stage, if possible. The simultaneous approach of CABG and ECICG should be the last of choice.