Terramani T T, Rowe V L, Hood D B, Eton D, Nuno I N, Yu H, Yellin A E, Starnes V A, Weaver F A
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
Am Surg. 1998 Oct;64(10):993-7.
The role of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in patients with severe asymptomatic carotid artery disease and concurrent symptomatic coronary artery disease is controversial. The objective of this report is to investigate the safety of combined CEA/CABG. The medical records of 30 patients who underwent combined CEA/CABG for coexistent asymptomatic carotid and symptomatic coronary artery occlusive disease were reviewed. All patients were scheduled for either elective or urgent myocardial revascularization due to their symptomatic coronary artery disease. Color-flow duplex scanning identified internal carotid artery stenosis of 80 to 99 per cent in 28 patients (93%) and 50 to 79 per cent in 2 patients (7%). Seventeen patients (57%) were male. The mean age was 64 +/- 10 years (range, 42-84 years). Contralateral internal carotid artery occlusion was present in four patients. Severe left main coronary artery disease was present in 12 patients (40%) and 7 patients (23%) had an ejection fraction of less than 50 per cent. There were no perioperative deaths or strokes. One patient suffered a myocardial infarction on postoperative day 1. This study demonstrates the safety of combined CEA/CABG for coexistent coronary and asymptomatic carotid disease. Using this surgical approach for critical coexistent disease may minimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.
对于患有严重无症状性颈动脉疾病且同时伴有症状性冠状动脉疾病的患者，联合行颈动脉内膜切除术（CEA）和冠状动脉旁路移植术（CABG）的作用存在争议。本报告的目的是研究CEA/CABG联合手术的安全性。回顾了30例因并存无症状性颈动脉和症状性冠状动脉闭塞性疾病而接受CEA/CABG联合手术患者的病历。所有患者均因症状性冠状动脉疾病而计划接受择期或急诊心肌血运重建。彩色血流双功扫描显示，28例患者（93%）颈内动脉狭窄80%至99%，2例患者（7%）颈内动脉狭窄50%至79%。17例患者（57%）为男性。平均年龄为64±10岁（范围42 - 84岁）。4例患者存在对侧颈内动脉闭塞。12例患者（40%）存在严重左主干冠状动脉疾病，7例患者（23%）射血分数低于50%。围手术期无死亡或卒中发生。1例患者在术后第1天发生心肌梗死。本研究证明了CEA/CABG联合手术治疗并存冠状动脉和无症状性颈动脉疾病的安全性。对于并存的严重疾病采用这种手术方法可能会使接受CABG手术患者围手术期脑血管并发症的发生率降至最低。
