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Updated: Aug 5, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Bilateral carotid endarterectomy combined with myocardial revascularization during the same surgical act
L A Mulinari1, A L Tyszka, A Z Silva
1Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.
Insights
Simultaneous carotid endarterectomy and coronary artery bypass surgery is a safe treatment option for patients with severe cerebral and coronary artery disease. This combined approach, using moderate hypothermia, effectively protected the brain during surgery.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
- Vascular Surgery
Background:
- Optimal surgical strategy for concurrent severe cerebral and coronary artery disease remains debated.
- Patients with severe carotid artery stenosis and coronary artery disease require careful management.
Observation:
- A 72-year-old female presented with unstable angina, triple coronary artery obstructive disease, and severe bilateral carotid artery stenosis.
- A simultaneous surgical procedure involving coronary artery bypass grafting and bilateral carotid endarterectomy was successfully performed.
Findings:
- The combined surgery utilized moderate hypothermia (32°C), total circulatory bypass, and hemodilution for cerebral protection.
- The patient experienced a satisfactory post-operative outcome, demonstrating the efficacy of the chosen method.
Implications:
- Moderate hypothermia and hemodynamic control offer effective cerebral protection during combined carotid endarterectomy and coronary artery bypass surgery.
- This simultaneous surgical approach is a safe and viable option for treating patients with complex cerebrovascular and coronary artery disease.
Abstract:
The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease still remains controversial. In this report we present a case of a 72-year-old female patient admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe bilateral carotid artery stenosis were diagnosed. A combined, simultaneous surgical procedure was performed. After total circulatory by-pass with a membrane oxygenator, the patient's body temperature was lowered to 32 degrees C. During the cool-down period, three proximal anastomoses of segments of autologous saphenous veins were performed in the ascending aorta. Immediately afterwards, bilateral carotid endarterectomy was performed, followed by three distal anastomoses to coronary arteries. The patient showed a satisfactory post-operative outcome. It was concluded that the combination of moderate hypothermia, hemodilution with appropriate hemodynamic control, as used in this patient, was an effective method of cerebral protection. The simultaneous approach of carotid endarterectomy and coronary artery by-pass surgery should be seen as a safe option for the treatment of this type of patient.
