Staged or Combined Approach for Carotid Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting: A 5-Year-Long Experience

Abstract

Staged and combined surgical approaches yield comparable outcomes. A staged approach may provide a more favorable neurological outcome with significantly reduced need for intraluminal shunting. Long-term outcome is, however, similar.

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

“…Use of intraluminal shunt and general anesthesia are routinely recommended in most studies, but unpleasant complications during placement of shunt into the internal carotid artery are well known. [20][21][22][23][24] Anesthesia is the one of the most controversial issues of carotid endarterectomy. Detailed studies have reported cervical blockage has better results concerning perioperative stroke and cardiac events, such as arrhythmia and infarction.…”

“…Intraluminal shunt use increased 20% to 25% in studies using EEG for cerebral monitoring, while 7% decrease was observed in patients who underwent carotid endarterectomy under regional anesthesia, which allows evaluation of consciousness and responses. [22,23] Furthermore, EEG cannot always detect perioperative cerebrovascular events. Regional anesthesia and awake patient provide precise information and evaluation, facilitating decision about shunt according to the case.…”

“…Most studies have found better results in terms of perioperative neurological complications with regional anesthesia compared with general anesthesia. [22,23] Rate of use of intraluminal shunts in carotid endarterectomy was 10% to 15% in the literature. [24,25] We used shunts in 2 patients (9.5%) who had critical contralateral carotid artery stenosis.…”

Prospective testing of the program for selecting the optimal surgical strategy in multifocal atherosclerosis

“…Отсутствие четких международных рекомендаций по выбору оптимальной стратегии реваскуляризации у пациентов с гемодинамически значимым поражением ВСА и коронарного русла связано с крайней вариабельностью клинических и инструментальных данных в группе больных с мультифокальным атеросклерозом (МФА). В связи с этим не может существовать универсальной хирургической стратегии реваскуляризации [11][12][13][14]. Речь может идти лишь о совершенствовании персонифицированного способа определения хирургической стратегии, ассоциированной с минимальной вероятностью развития неблагоприятных кардиоваскулярных событий у конкретного пациента [10,15].…”