Fukuda I, Osaka M, Nakata H, Sakamoto H
Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki 305-8558.
J Cardiol. 2001 Dec;38(6):303-9.
To evaluate the management of coexisting severe carotid stenosis in candidates for coronary artery bypass grafting.
Twenty-six candidates for coronary artery bypass complicated with severe carotid stenosis > or = 70% were analyzed retrospectively. The prevalence of significant carotid stenosis was 6.4%. There were 21 males and 5 females with a mean age of 65.3 +/- 9.3 years. The hemodynamics of cerebral circulation, intervention for carotid stenosis, surgical mortality, morbidity, and long-term survival were analyzed retrospectively.
The prevalence of bilateral carotid stenosis was 30.8% (8/26). Nine patients had total occlusion of the internal carotid artery, 10 had carotid stenosis of 90-99%, and 7 had carotid stenosis of 70-89%. Seven patients required mechanical support for cardiopulmonary insufficiency, including six patients requiring simultaneous artificial ventilation and intraaortic balloon pumping, and one requiring intraaortic balloon pumping. Concomitant carotid endarterectomy and coronary bypass grafting was performed in 10 patients, preceding carotid endarterectomy in 1, and preceding coronary bypass grafting with subsequent carotid endarterectomy in 7. Cardiopulmonary bypass was used in 22 patients. There was no surgical death. Although one patient undergoing concomitant carotid endarterectomy and coronary artery bypass grafting had perioperative stroke, the remaining patients recovered without any neurological complication (morbidity of stroke: 3.8%). The five-year survival rate was 71.9 +/- 11.7%.
Coronary artery bypass grafting in candidates with carotid stenosis can be treated safely when appropriate preoperative evaluation and surgical strategies are utilized.
评估冠状动脉旁路移植术候选患者中并存的严重颈动脉狭窄的处理。
回顾性分析26例冠状动脉旁路移植术合并严重颈动脉狭窄（≥70%）的患者。显著颈动脉狭窄的患病率为6.4%。其中男性21例，女性5例，平均年龄65.3±9.3岁。回顾性分析脑循环的血流动力学、颈动脉狭窄的干预措施、手术死亡率、发病率和长期生存率。
双侧颈动脉狭窄的患病率为30.8%（8/26）。9例患者颈内动脉完全闭塞，10例患者颈动脉狭窄90%-99%，7例患者颈动脉狭窄70%-89%。7例患者因心肺功能不全需要机械支持，其中6例患者需要同时进行人工通气和主动脉内球囊反搏，1例需要主动脉内球囊反搏。10例患者同时进行了颈动脉内膜切除术和冠状动脉旁路移植术，1例先进行颈动脉内膜切除术，7例先进行冠状动脉旁路移植术，随后进行颈动脉内膜切除术。22例患者使用了体外循环。无手术死亡。虽然1例同时进行颈动脉内膜切除术和冠状动脉旁路移植术的患者发生了围手术期卒中，但其余患者恢复良好，无任何神经并发症（卒中发病率：3.8%）。五年生存率为71.9±11.7%。
当采用适当的术前评估和手术策略时，颈动脉狭窄患者的冠状动脉旁路移植术可以安全进行。
