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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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Combined surgical treatment of symptomatic carotid, coronary and mesenteric occlusive disease

Dante C Dali1, Satvik Jhamb1, C Steven Powell1

  • 1Divisions of Cardiac and Vascular Surgery, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute at East Carolina University, Greenville, NC, USA.

Journal of Surgical Case Reports
|February 18, 2020
PubMed

Insights

This study presents a novel surgical approach for managing complex atherosclerotic disease affecting the carotid, coronary, and mesenteric arteries. The combined procedure proved safe and feasible, offering a potential solution for patients with multi-site vascular disease.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Disease Management
  • Atherosclerosis Research

Background:

  • Advanced atherosclerotic disease in multiple arterial beds poses significant surgical challenges, particularly concerning perioperative ischemic events.
  • Coronary artery bypass grafting (CABG) is associated with high risks in patients with concurrent carotid or mesenteric ischemia.
  • Multivessel atherosclerotic disease requires careful, integrated surgical planning.

Observation:

  • A unique case involved a patient with symptomatic carotid, coronary, and mesenteric ischemic disease.
  • The patient underwent carotid endarterectomy, followed by combined coronary and mesenteric revascularization.
  • Cardiopulmonary bypass was utilized for the combined revascularization during the same hospital admission.

Findings:

  • The patient experienced an uncomplicated postoperative course, discharged on postoperative day 7.
  • Ninety-day follow-up revealed no recurrent ischemic symptoms.
  • This combined surgical strategy demonstrated feasibility and safety in this rare presentation.

Implications:

  • This approach may offer a viable treatment option for patients with complex, multi-site atherosclerotic disease.
  • Successful management highlights the potential for staged or combined interventions in high-risk vascular patients.
  • Further research could explore the broader applicability and long-term outcomes of this surgical technique.

Keywords:
carotid endarterectomycoronary artery bypass graftingmesenteric revascularization

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