Complete carotid and coronary revascularization in brain malperfusion

Area of Science:

• Cardiovascular Surgery
• Neurological Surgery
• Vascular Surgery

Background:

• The patient presented with severe, multi-vessel coronary artery disease and significant carotid artery stenosis, posing a high risk for cardiovascular and cerebrovascular events.
• Unstable angina and stroke with right hemiplegia and aphasia indicated critical ischemia requiring urgent intervention.

Observation:

• A 54-year-old male patient exhibited symptoms of unstable angina and stroke.
• Diagnostic imaging revealed left main coronary artery disease with three-vessel involvement, alongside severe stenosis in bilateral internal carotid, proximal left common carotid, and proximal left subclavian arteries.

Findings:

• Simultaneous complete revascularization was performed using conventional cardiopulmonary bypass and moderate hypothermia (25°C).
• Coronary artery bypass utilized the left internal mammary artery and two saphenous vein grafts.
• Cerebrovascular reconstruction involved a left aorta-to-common carotid Dacron graft and bilateral carotid endarterectomy.

Implications:

• This case demonstrates the feasibility and effectiveness of a combined surgical strategy for patients with concurrent severe coronary and cerebrovascular disease.
• Simultaneous revascularization can achieve complete revascularization, potentially improving outcomes and reducing the need for staged procedures.
• The successful recovery suggests that this aggressive surgical approach is a valuable option for select high-risk patients.