Garg Arun, Bansal Atma Ram, Singh Dilip, Mishra Manisha, Sharma Pooja, Kasliwal Ravi Ratan, Trehan Naresh
Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
Ann Indian Acad Neurol. 2015 Oct-Dec;18(4):419-23. doi: 10.4103/0972-2327.165457.
We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation.
To find out safety and efficacy of synchronous CEA in patients undergoing CABG.
Retrospective study.
Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months.
One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period.
Combining CEA along with CABG is a safe and effective procedure.
作为神经科医生，我们经常被咨询，为正在接受冠状动脉搭桥术（CABG）且既往有中风或短暂性脑缺血发作（TIA）的患者进行手术的神经学评估。同样，另一组患者也会寻求评估，这些患者虽然没有中风或TIA病史，但在手术前的常规筛查中发现有严重的颈动脉狭窄。心脏外科医生和麻醉师想了解这类患者围手术期中风的风险，以及是否应在CABG的同时进行颈动脉内膜切除术（CEA）。由于缺乏明确的指导方针，神经科医生往往无法给出具体建议。
了解同步进行CEA对接受CABG患者的安全性和有效性。
回顾性研究。
在3700例接受CABG的患者中，发现150例有严重颈动脉狭窄，狭窄程度>70%。其中，46例狭窄程度>80%的患者（3例有症状，43例无症状）和1例狭窄程度>70%的有症状颈动脉狭窄患者（在过去2周内发生TIA）在进行CABG的同时接受了同步CEA。这3例有症状的颈动脉患者在过去6个月内曾发生中风。
1例无症状的颈动脉近乎完全闭塞的患者发生了高灌注综合征。围手术期无患者发生缺血性中风、心肌梗死（MI）或死亡。
CEA与CABG联合是一种安全有效的手术方法。
