Komatsu Y, Nakai K, Aoki K, Uemura K, Shibata T, Yoshizawa T, Kobayashi E, Koishizawa T, Sakakibara Y, Hiramatsu Y, Nose T
Department of Neurosurgery, Tsukuba Medical Center 1-3-1 Amakubo, Tsukuba-shi, Ibaraki-ken, 305-8558, Japan.
No Shinkei Geka. 2001 Jan;29(1):65-9.
Some patients with coronary artery disease are diagnosed as having additional carotid artery disease. This subset of patients has been identified as a high-risk group for cardiac and cerebral complications following surgical intervention. Three patients who underwent combined CEA/CABG for coexistent asymptomatic carotid occlusive disease are reported. Case 1: A 69-year-old female who suffered chest pain on exertion. Her coronary angiogram showed severe stenosis of three vessels. Her carotid angiogram showed 98% stenosis of the right internal carotid artery and poor collateral circulation. The severe stenosis of her carotid artery was considered as a risk factor for perioperative cerebral stroke. Intraoperatively, CEA preceded the CABG. Postoperative course was uneventful. Case 2: A 64-year-old male. Intermittent claudication was his initial symptom. His coronary angiogram showed stenosis in three vessels and carotid angiogram showed 75% stenosis in the right carotid artery. Simultaneous CABG and CEA was performed. His postoperative course was uneventful. Case 3: A 62-year-old male whose ECG indicated ischemic heart disease, although he had no symptoms. His coronary angiogram showed stenosis in three vessels, and 80% stenosis of his right carotid artery was observed by carotid angiogram. He underwent simultaneous surgery, and had an uneventful postoperative course. It has been reported that 1.5-8.7% of CABG patients have severe carotid artery stenosis, and perioperative cerebral stroke occurs in 0.9-16%. Simultaneous surgery was successful in our three patients who had asymptomatic carotid artery stenosis. Using this surgical approach for critical coexistent disease may minimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.
一些冠心病患者被诊断出还患有颈动脉疾病。这部分患者已被确定为手术干预后发生心脏和脑部并发症的高危人群。本文报告了3例因无症状性颈动脉闭塞性疾病而接受CEA/CABG联合手术的患者。病例1：一名69岁女性，劳力性胸痛。冠状动脉造影显示三支血管严重狭窄。颈动脉造影显示右侧颈内动脉狭窄98%，侧支循环不良。其颈动脉严重狭窄被视为围手术期脑卒中的危险因素。术中，CEA先于CABG进行。术后过程顺利。病例2：一名64岁男性。间歇性跛行是其初始症状。冠状动脉造影显示三支血管狭窄，颈动脉造影显示右侧颈动脉狭窄75%。同时进行了CABG和CEA。术后过程顺利。病例3：一名62岁男性，尽管无症状，但心电图显示有缺血性心脏病。冠状动脉造影显示三支血管狭窄，颈动脉造影显示右侧颈动脉狭窄80%。他接受了同期手术，术后过程顺利。据报道，1.5 - 8.7%的CABG患者存在严重颈动脉狭窄，围手术期脑卒中发生率为0.9 - 16%。我们的3例无症状性颈动脉狭窄患者同期手术均获成功。对于并存的严重疾病采用这种手术方法可能会使接受CABG的患者围手术期脑血管并发症的发生率降至最低。
