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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
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[Management of coexistent advanced coronary artery disease and internal carotid artery stenosis]

Anna Kabłak-Ziembicka1, Marta Hlawaty, Jerzy Sadowski

  • 1Klinika Chorób Serca i Naczyń Instytutu Kardiologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.

Przeglad Lekarski
|January 9, 2003
PubMed

Insights

A 60-year-old man with unstable angina and carotid artery stenosis underwent a two-stage treatment. Carotid endarterectomy (CEA) was performed first, followed by coronary artery bypass grafting (CABG) a month later, yielding a good outcome.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • The patient presented with symptoms indicative of unstable angina and significant carotid artery stenosis.
  • Diagnostic imaging revealed three-vessel coronary artery disease and high-grade left internal carotid artery stenosis with a thrombosed aneurysm.

Observation:

  • A 60-year-old male patient experienced symptoms of unstable angina and carotid artery stenosis.
  • Coronary angiography identified three-vessel coronary artery disease.
  • Doppler ultrasound and multislice spiral computed tomography confirmed high-grade left internal carotid artery stenosis with a poststenotic aneurysm containing thrombi.

Findings:

  • A high-risk assessment for simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) was determined.
  • A staged surgical approach was chosen, commencing with CEA.
  • The patient subsequently underwent CABG one month after CEA, with successful results.

Implications:

  • This case highlights the successful management of complex cardiovascular and cerebrovascular disease through a staged surgical approach.
  • The findings suggest that a staged CEA followed by CABG can be a safe and effective strategy in high-risk patients.
  • This approach may reduce perioperative risks associated with combined procedures for severe coronary artery disease and carotid stenosis.

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