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Combined carotid endarterectomy and coronary artery bypass graft
K Yanaka1, K Meguro, K Narushima
1Department of Neurosurgery, Tsukuba Medical Center, Ibaraki, Japan.
Insights
Simultaneous carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) can be performed safely. Intraoperative digital subtraction angiography (DSA) aids in preventing stroke during combined procedures for atherosclerosis.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Diagnostic Imaging
Background:
- Atherosclerosis commonly affects both carotid and coronary arteries.
- Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is often preferred over staged procedures despite perceived higher risks.
- Neurological complications post-CEA are challenging to monitor during subsequent CABG under general anesthesia.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous CEA and CABG.
- To assess the utility of intraoperative portable digital subtraction angiography (DSA) in combined procedures.
- To investigate the prevention of perioperative stroke in patients undergoing combined CEA and CABG.
Main Methods:
- Retrospective study of six patients undergoing simultaneous CEA and CABG between 1989 and 1997.
- Utilization of intraoperative portable digital subtraction angiography (DSA) to assess internal carotid artery patency and detect flap formation after CEA.
- Performance of CABG following CEA under general anesthesia and extracorporeal circulation.
Main Results:
- The combined procedure demonstrated 0% postoperative mortality and morbidity in the studied cohort.
- Intraoperative DSA confirmed internal carotid artery patency and absence of flap formation post-CEA.
- The use of intraoperative DSA facilitated safe performance of subsequent CABG.
Conclusions:
- Simultaneous CEA and CABG can be safely performed using intraoperative portable DSA.
- Intraoperative DSA is a valuable tool for preventing perioperative stroke in combined CEA and CABG procedures.
- This approach offers a safe alternative for patients requiring treatment for both carotid and coronary atherosclerosis.
Abstract:
Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after CEA because the patient must be maintained under general anesthesia and extracorporeal circulation during the subsequent CABG. However, intraoperative DSA can confirm patency of the internal carotid artery and absence of flap formation after CEA, and the CABG can be performed safely. Intraoperative portable DSA between CEA and CABG is helpful in preventing perioperative stroke in the combined procedure.