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Bilateral carotid stenting prior to coronary artery bypass graft: a case report
Suphot Srimahachota1, Seri Singhatanadgige, Smonporn Boonyaratavej
1Cardiac Center and Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Insights
Bilateral carotid stenting is a safe and effective treatment for patients undergoing coronary artery bypass graft (CABG) surgery, significantly reducing stroke risk. This procedure offers an alternative to prevent neurological complications in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Neurology
- Vascular Medicine
Background:
- Coronary artery bypass graft (CABG) surgery carries a risk of central nervous system complications, particularly in patients with asymptomatic bilateral carotid stenosis.
- Identifying and managing carotid stenosis is crucial for optimizing outcomes in patients undergoing CABG.
Observation:
- A 76-year-old female with unstable angina and triple-vessel disease underwent evaluation for CABG.
- Physical examination revealed bilateral carotid bruits, and Doppler/angiography confirmed critical stenosis (70%) in both internal carotid arteries.
- The patient had no prior neurological deficits.
Findings:
- Successful bilateral carotid artery stenting was performed using self-expandable stents prior to CABG.
- The procedure resulted in no residual stenosis and no immediate cardiovascular complications.
- Coronary artery bypass graft surgery was successfully completed two weeks post-stenting.
Implications:
- Bilateral carotid stenting is a feasible and safe alternative treatment for stroke prevention in patients undergoing CABG.
- This approach can mitigate neurological risks associated with major cardiac surgery in patients with significant carotid artery disease.
Background:
Carotid stenosis is an independent possible complication of the central nervous system of patients after receiving a coronary artery bypass graft (CABG). The risk increases when the patient has bilateral carotid stenosis even if asymptomatic.
Case Report:
A 76 year-old female was admitted because of unstable angina. The coronary angiography showed triple vessel disease and required CABG for revascularization. Her physical examination revealed bilateral carotid bruits. She did not have any history of neurological deficit. Carotid Doppler showed critical stenosis of bilateral carotid arteries. The carotid angiography demonstrated 70 per cent diameter stenosis of both internal carotid arteries just above the bifurcation of the external carotid artery. A 7 x 20 mm self-expandable Smart stent was implanted first in the right carotid artery with good angiographic result. Five days later, another 7 x 20 mm self-expandable Smart stent was implanted in the left carotid artery without residual stenosis. The patient did not have any cardiovascular complications. CABG was performed 2 weeks later with a good result. The patient was discharged 10 days after CABG.
Conclusion:
Bilateral carotid stenting is feasible and produces an acceptable outcome. This procedure is an alternative treatment for preventing stroke during CABG surgery.