[Surgical decision-making during treatment of a patient with multifocal atherosclerosis based on intraoperative...

The article deals with a clinical case report regarding surgical management of a patient presenting with multifocal atherosclerosis. Taking into consideration critical stenoses of the anterior interventricular artery (80%) and circumflex artery (80%), as well as subocclusion of the left internal carotid artery and stenosis of the right internal carotid artery (60%), there were high risks for intraoperative cerebral circulation impairment. It was decided to perform a two-stage operation on the coronary and carotid beds. The envisaged scope of the intervention comprised: carotid endarterectomy on the left and coronary bypass grafting of the anterior interventricular and circumflex arteries in conditions of assisted circulation. The intraoperative epiaortic scanning revealed atheromatosis of the ascending portion of the aorta, thus making it impossible to cross-clamp the aorta for establishing distal anastomoses on the non-beating heart and proximal anastomoses on the aorta. A decision was made to change the treatment policy. The patient was subjected to endarterectomy from the left internal carotid artery and mammarocoronary bypass grafting of the anterior interventricular artery on the beating heart with the help of the Octopus myocardial stabiliser. The second stage consisted in stenting of the circumflex artery. This clinical case report demonstrates the necessity of precision diagnosis of an atherosclerotic lesion of the aorta by means of epiaortic scanning in order to prevent perioperative acute impairments of cerebral circulation.