Simultaneous approach of internal carotid artery revascularization at the base of the skull and coronary arteries bypass without extracorporeal circulation

Abstract

The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease remains controversial. In this report, we present a case of a 65-year-old man admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe right internal carotid artery stenosis in the retroparotid region were diagnosed. A combined, simultaneous surgical procedure was performed. A lesion located in the retroparotid space required an approach by a presternocleidomastoid cervicotomy extended distally. Venous grafting of the internal carotid artery was performed. After carotid reconstruction, the three coronary arteries were revascularized without extracorporeal circulation. The patient showed a satisfactory postoperative outcome.

Simultaneous bicarotid and microscope-assisted coronary revascularization as an individual surgical strategy

“…Therefore, placing emphasis on the assessment of prevailing risks of developing each of these complications is essential to a choice of strategy for surgical treatment in patients with significant concomitant lesions in carotid and coronary arteries. The existing approaches to surgical treatment of this category of patients remain controversial and vary from staged interventions in different sequences to simultaneous operations [ 1 , 2 ].…”

“…In the current practice, there are several strategies for surgical treatment of patients with combined lesions of the coronary and brachiocephalic arteries: carotid endarterectomy before CABG; simultaneous carotid endarterectomy and CABG; stenting of brachiocephalic arteries before CABG; and interventions on the carotid arteries after CABG. Nonetheless, there is no standardized approach to making decisions as to a choice of preferred strategies [ 1 – 3 ].…”

Simultaneous bilateral aortic-carotid replacement and coronary artery bypass grafting by using of microvascular technique and surgical microscope

“…щения после КШ увеличивается с 2% у лиц без поражения брахиоцефальных артерий до 3% при стенозе одной из СА выше 60%, до 5% у пациентов с двусторонним значимым поражением каротидных артерий и до 7-11% у пациентов с окклюзией одной из СА. По этой причине пациенты со сложным окклюзионно-стенотическим поражением коронарного русла и билатеральным поражением СА нуждаются в индивидуальном подходе с обоснованным определением как этапности вмешательств, так и методов реваскуляризации [3,4,6,7].…”