Graor R A, Hetzer N R
Department of Peripheral Vascular Disease, Cleveland Clinic Foundation, Ohio.
Stroke. 1988 Nov;19(11):1441-4. doi: 10.1161/01.str.19.11.1441.
At the present time staged carotid reconstruction several days before elective coronary artery bypass surgery seems to be the safest and most logical approach for patients with neurological symptoms, stable cardiac symptoms, and acceptable coronary anatomy. Combined procedures may well be necessary for those who have active neurological symptoms or bilateral carotid lesions in conjunction with diffuse or unstable coronary artery disease, but the incidence of neurological complications at the time of simultaneous operations could exceed the stroke risk for either carotid endarterectomy or coronary bypass alone. The asymptomatic patient with unilateral carotid stenosis who presents for coronary artery bypass might be best managed by myocardial revascularization followed by medical or surgical management of the carotid disease. In order to obtain optimal long-term results, both coronary disease and associated carotid disease require appropriate evaluation and medical and surgical management.
目前，对于有神经症状、心脏症状稳定且冠状动脉解剖结构可接受的患者，在择期冠状动脉搭桥手术前几天进行分期颈动脉重建似乎是最安全、最合理的方法。对于那些有活动性神经症状或双侧颈动脉病变合并弥漫性或不稳定冠状动脉疾病的患者，联合手术可能是必要的，但同时进行手术时神经并发症的发生率可能超过单独进行颈动脉内膜切除术或冠状动脉搭桥术的中风风险。因冠状动脉搭桥手术前来就诊的无症状单侧颈动脉狭窄患者，最好先进行心肌血运重建，然后对颈动脉疾病进行药物或手术治疗。为了获得最佳的长期效果，冠状动脉疾病和相关的颈动脉疾病都需要进行适当的评估以及药物和手术治疗。
