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Báo cáo y học: "Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report."

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report. | Bellos et al. Journal of Cardiothoracic Surgery 2011 6 33 http www.cardiothoracicsurgery.Org content 6 1 33 JCTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis a case report 1 2 2 1 2 John K Bellos Nektarios Kogerakis Charalampos Kiriazis Alexandros Gougoulakis Matthew Panagiotou Abstract Background Management of patients with co-existent coronary and carotid disease is a controversial and challenging issue. The risk for stroke after coronary artery bypass grafting CABG in patients with hemodynamically significant carotid stenosis is up to 30 . In these patients a common practice is to proceed first with the restoration of cerebral perfusion and then perform the coronary revascularization. The rationale is that this strategy will reduce perioperative neurological morbidity and mortality. However what happens when the carotid procedure is acutely complicated by cardiac instability which necessitates the interruption of the carotid procedure Case report We describe a case of a patient with unstable angina and high grade asymptomatic bilateral carotid stenosis who underwent emergency combined CABG and carotid endarterectomy CEA . Due to hemodynamic instability ST-T changes hypotension and bradycardia upon completion of endarterectomy we placed a carotid shunt and the patient was put on cardiopulmonary bypass through median sternotomy. After triple CABG duration of 90 minutes we concluded the interrupted CEA procedure with primary closure of the carotid arteriotomy with the shunt in place. The postoperative course was uneventful and the patient was discharged after a week. In extreme cases with bilateral severe carotid stenosis and coronary artery disease where the carotid procedure should be interrupted we suggest the use of carotid shunt which can provide adequate cerebral perfusion giving time to cardiac .