Cherniavskiĭ M A, Gusev A A, Chernova D V, Iarkov I V, Gordeev M L
Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia.
Angiol Sosud Khir. 2018;24(2):165-170.
Prevention of neurological complications in cardiosurgical and reconstructive vascular surgery is one of the priority tasks of preserving ability to work and decreasing invalidization of patients in the postoperative period. Presented in the article is a clinical case report regarding multiple-stage treatment of a female patient with a combined aortic defect, coronary pathology, and a multilevel bilateral lesion of the brachiocephalic arteries. The first stage consisted in performing a hybrid operation, i. e., carotid endarterectomy from the right internal carotid artery and stenting of the ostium of the right common carotid artery (CCA). The second stage involved balloon angioplasty with stenting of the left CCA, and the third stage was prosthetic repair of the aortic valve by a mechanical prosthesis with simultaneous coronary artery bypass grafting. The woman was discharged in a satisfactory condition. Described in details is the technique of performing the hybrid vascular operation, followed by substantiating the stagewise nature of surgical interventions. The policy chosen demonstrates effective and safe correction of haemodynamically significant tandem stenoses of brachiocephalic arteries, without neurological complications during treatment of patients with cardiological pathology.
预防心脏外科手术和血管重建手术中的神经并发症是术后保持患者工作能力和降低致残率的首要任务之一。本文介绍了一名患有主动脉复合缺损、冠状动脉病变以及头臂动脉多节段双侧病变的女性患者的多阶段治疗临床病例报告。第一阶段包括进行杂交手术，即右侧颈内动脉内膜切除术和右侧颈总动脉开口支架置入术。第二阶段是左侧颈总动脉球囊血管成形术及支架置入术，第三阶段是使用机械瓣膜进行主动脉瓣人工修复并同时进行冠状动脉搭桥术。该女性患者出院时情况良好。详细描述了杂交血管手术的操作技术，并论证了手术干预分阶段进行的合理性。所选择的策略显示出对血流动力学上具有显著意义的头臂动脉串联狭窄进行有效且安全的矫正，在治疗心脏病患者期间无神经并发症。
