Mertens R, Valdés F, Krämer A, Morán S, Zalaquett R, Irarrázaval M, Maturana G
Departamento de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile.
Rev Med Chil. 1996 Dec;124(12):1462-6.
Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarction can occur after carotid endarterectomy and stroke is a well documented morbidity of coronary artery bypass grafting. To optimize results, we have performed concomitant carotid endarterectomy and myocardial revascularization in selected cases, with severe disease in both territories. During a 13-year period, 27 patients were submitted for this procedure, 21 (77.8%) were male and the average age was 67.6 years (range 59-81). All patients had high-grade internal carotid artery stenosis, five (18.5%) were symptomatic. Coronary artery disease symptoms were: unstable angina in 12 patients (44.4%) and effort angina in 15 (55.6%). Two patients (7.4%) required reintervention for postoperative bleeding. Two cases (7.4%) had transient renal dysfunction. One patient, with multiple organ failure, died on the 16th postoperative day (3.7%). Follow up was obtained in 26 patients (96.3%). Survival at 5 years was 80.6%, 95.7% of those patients were free of any neurologic symptom. Combined carotid and coronary surgery is a safe treatment option for atherosclerosis of multiple territories in selected patients; long term benefits are also obtained.
动脉粥样硬化是一种可能累及多个区域的全身性疾病。颈动脉内膜切除术后可能发生心肌梗死，而冠状动脉旁路移植术的卒中发病率也有充分记录。为了优化治疗效果，我们在部分双侧均患有严重疾病的病例中同时进行了颈动脉内膜切除术和心肌血运重建术。在13年的时间里，有27例患者接受了该手术，其中21例（77.8%）为男性，平均年龄为67.6岁（范围59 - 81岁）。所有患者均患有重度颈内动脉狭窄，5例（18.5%）有症状。冠状动脉疾病症状为：12例患者（44.4%）出现不稳定型心绞痛，15例（55.6%）出现劳力性心绞痛。2例患者（7.4%）因术后出血需要再次干预。2例（7.4%）出现短暂性肾功能不全。1例多器官功能衰竭患者在术后第16天死亡（3.7%）。26例患者（96.3%）获得了随访。5年生存率为80.6%，其中95.7%的患者没有任何神经症状。对于部分选定患者的多区域动脉粥样硬化，联合颈动脉和冠状动脉手术是一种安全的治疗选择；也能获得长期益处。
