Yeager R A, Moneta G L, McConnell D B, Neuwelt E A, Taylor L M, Porter J M
Surgical Service, Veterans Administration Medical Center, Portland, OR 97207.
Arch Surg. 1989 Oct;124(10):1142-5. doi: 10.1001/archsurg.1989.01410100040008.
A 4-year experience with 249 consecutive carotid endarter-ectomies performed on 224 patients is reviewed for incidence of perioperative (30-day) myocardial infarction and early survival (mean follow-up, 21 months). Except in cases of unstable angina, coronary arterial disease was evaluated only by routine history, physical examination, and electrocardiogram. By these criteria, 73% of patients had evidence of coronary arterial disease. Patients underwent carotid endarterectomy after appropriate medical management and stabilization of coronary disease symptoms (angina and/or congestive heart failure). One (0.4%) fatal and nine (3.6%) nonfatal perioperative myocardial infarctions Early survival of patients with active symptoms of coronary disease who did not undergo coronary bypass was similar to those patients with preceding or subsequent coronary bypass. The results of this review suggest routine clinical evaluation for coronary arterial disease is sufficient in the large majority of cases prior to carotid endarterectomy. Considering the reported high mortality of coronary bypass among vascular surgical patients, it appears that an aggressive program screening for cardiac surgical candidates either by coronary arteriography or radionuclide studies prior to carotid endarterectomy is not warranted.
回顾了对224例患者连续进行249例颈动脉内膜切除术的4年经验，以了解围手术期（30天）心肌梗死的发生率和早期生存率（平均随访21个月）。除不稳定型心绞痛病例外，仅通过常规病史、体格检查和心电图评估冠状动脉疾病。根据这些标准，73%的患者有冠状动脉疾病的证据。患者在接受适当的药物治疗并稳定冠状动脉疾病症状（心绞痛和/或充血性心力衰竭）后接受颈动脉内膜切除术。1例（0.4%）围手术期心肌梗死死亡，9例（3.6%）非致命性围手术期心肌梗死。未进行冠状动脉搭桥术的有冠心病活动症状患者的早期生存率与之前或之后进行冠状动脉搭桥术的患者相似。该综述结果表明，在大多数情况下，颈动脉内膜切除术之前对冠状动脉疾病进行常规临床评估就足够了。考虑到血管外科患者中报道的冠状动脉搭桥术的高死亡率，在颈动脉内膜切除术之前通过冠状动脉造影或放射性核素研究对心脏手术候选人进行积极筛查似乎没有必要。
