[Revascularization for simultaneous carotid and coronary ischemia].

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.