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[Revascularization for simultaneous carotid and coronary ischemia]
K H Niijima1, Y Yonekawa, W Taki
1Department of Neurosurgery, National Cardiovascular Center, Osaka, Japan.
Insights
For patients with both cerebral ischemia and coronary insufficiency, staged surgery is recommended. Preliminary extracranial-intracranial (EC-IC) bypass followed by coronary artery bypass grafting (CABG) offers a successful approach.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Patients with cerebral ischemia often present with concurrent coronary insufficiency, necessitating complex surgical interventions.
- Simultaneous carotid endarterectomy and coronary artery bypass grafting (CABG) are reported, but combining EC-IC bypass with CABG is less common.
- The risks associated with CABG, such as hypotension and heparinization, can exacerbate cerebral ischemia or intracranial hemorrhage.
Observation:
- Extracranial-intracranial (EC-IC) bypass can be performed safely if cardiac conditions are meticulously managed during surgery.
- The study investigates the optimal surgical strategy for patients requiring both EC-IC bypass and CABG.
- Two cases involving staged revascularization, prioritizing EC-IC bypass before CABG, were successfully managed.
Findings:
- A staged approach, beginning with EC-IC bypass followed by CABG, is presumed to be the preferred method for managing simultaneous carotid and coronary ischemia.
- This staged strategy mitigates the risks associated with performing CABG in the presence of cerebral ischemia.
- Successful outcomes were achieved in two patients who underwent this staged revascularization procedure.
Implications:
- The findings suggest that a preliminary EC-IC bypass followed by CABG is a viable and effective treatment strategy for select patients.
- This approach may improve patient outcomes by reducing the risks of perioperative neurological complications.
- Further research into staged revascularization for combined cerebrovascular and coronary disease is warranted.
Abstract:
Some of the patients who suffer from cerebral ischemia may at the same time have coronary insufficiency. For such cases, not only extracranial-intracranial (EC-IC) bypass but also cardiac revascularization is considered to be necessary. One-stage surgery of both carotid endarterectomy and coronary artery bypass grafting (CABG) has not infrequently been published. However, the combination of EC-IC bypass and CABG is rarely reported in the literature. The indication of EC-IC bypass and/or CABG for such patients above stated has been searched for. In fact, CABG runs the risk of aggravating cerebral ischemia and/or intracranial hemorrhage by inevitable hypotension, hypothermia and heparinization of a large amount, while EC-IC bypass may safely be carried out so long as cardiac conditions are carefully controlled during the operation. It is consequently presumed that the preliminary EC-IC bypass followed by CABG seems to be the method of choice for simultaneous carotid and coronary ischemia. Two cases underwent the staged revascularization, first for the brain and next for the heart, with a successful result are reported in the present paper.