Perler B A, Burdick J F, Minken S L, Williams G M
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
J Vasc Surg. 1988 Oct;8(4):402-9.
From Jan. 1, 1979 through July 31, 1987, 63 patients had carotid endarterectomy (CEA) concurrently with cardiac surgical procedures including coronary artery bypass grafting (CABG) in 61, CABG plus mitral value replacement in one, and aortic valve replacement in one. Among the 62 patients having CABG, unstable angina had been present in 36 (58%), left main coronary artery disease in 21 (34%), and both unstable angina and left main coronary artery disease in 13 (21%). Indications for carotid surgery included previous stroke, amaurosis fugax, or hemispheric transient ischemic attacks (TIAs) in 33 patients (52%); bilaterally significant carotid disease was noted in 48% of the patients. Major neurologic complications occurred in three patients (4.8%), including perioperative stroke in two (3.2%) (fatal in one) and a TIA in a third patient. Bilateral carotid lesions, a contralateral total carotid occlusion, previous cerebrovascular symptoms, and intraaortic balloon pump support did not increase neurologic risk. Seven patients died postoperatively (11%). The mortality rate was 2.8% in patients younger than 65 years vs 22% in patients 65 years or older, 19% in patients with left main coronary artery disease vs 7.3% in patients without, 13.3% in men vs 5.6% in women, 25% in patients with a history of congestive heart failure vs 7.8% in patients without failure, and 6.2% in patients with unilateral carotid disease, 17% in patients with bilateral carotid disease, and 23% in patients with bilateral disease including a contralateral carotid occlusion. A mortality predictive index (MPI) was developed to summarize individual risk for a fatal outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
1979年1月1日至1987年7月31日期间，63例患者同期接受了颈动脉内膜切除术（CEA）及心脏外科手术，其中61例接受冠状动脉旁路移植术（CABG），1例接受CABG加二尖瓣置换术，1例接受主动脉瓣置换术。在62例接受CABG的患者中，36例（58%）曾有不稳定型心绞痛，21例（34%）有左主干冠状动脉疾病，13例（21%）既有不稳定型心绞痛又有左主干冠状动脉疾病。颈动脉手术的指征包括既往中风、一过性黑矇或半球性短暂性脑缺血发作（TIA），共33例患者（52%）；48%的患者存在双侧显著颈动脉疾病。3例患者（4.8%）发生了严重神经并发症，包括2例围手术期中风（3.2%）（1例死亡）和第3例患者发生TIA。双侧颈动脉病变、对侧颈总动脉完全闭塞、既往脑血管症状及主动脉内球囊泵支持均未增加神经风险。7例患者术后死亡（11%）。65岁以下患者的死亡率为2.8%，65岁及以上患者为22%；有左主干冠状动脉疾病的患者为19%，无左主干冠状动脉疾病的患者为7.3%；男性为13.3%，女性为5.6%；有充血性心力衰竭病史的患者为25%，无心力衰竭病史的患者为7.8%；单侧颈动脉疾病患者为6.2%，双侧颈动脉疾病患者为17%，包括对侧颈动脉闭塞的双侧疾病患者为23%。制定了死亡率预测指数（MPI）以总结个体的致命结局风险。（摘要截短于250词）
