Surgical Tactics in Patients with Carotid Artery Disease (Stenosis) and Coronary Artery Disease

Arthur Ozolinsh, Nidal Darvish, Igor Sigaev, Mikhail Alshibaya, Vadim Merzlyakov, Irakliy Gvetadze, Mussa Eseneev, Ramilya Valieva, Nataliya Svetlova, Shorena Zarandiya

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

Target of the research was analisys of results of surgical treatment of patients with combined carotid and coronary artery stenosis, development of the algorythm of diagnostics and tactics of surgical treatment, and evaluation of results of surgical treatment.

Material and methodics. From 2012 to 2017 500 patients was operated on carotid and coronary arteries. Mean age was 62,4±5,7. Gender male 62,5%, female 37,5%. All patients were cheked with coronarography, angiography of brachiocefalic arteries, ultrasound diagnostics, echocardiography, electrocardiography. Extended diagnostics include brain neurovisualisation (magnetic resonance investigation or multispiral computer tomography), diagnostics of brain perfusion reserve, miocardial and coronary reserve. Also the cardiological and neurological status before and after the operation was cheked.

First group of patients with low brain perfusion reserve and low coronary (miocardial) reserve undergo combined surgical treatment on both coronary and carotid arteries in one operation. Second group with high brain perfusion reserve and low coronary reserve first undergo coronary artery bypass and then (period from 1 day to 3 month, mean 2 month) carotid endarterectomy. Third group undergo carotid endarterectomy and then coronary bypass (period from 1 to 3 monthes, mean 2,5 monthes).

Results. Lethal 2%, neurological disorders (including stroke, transient ischaemia, swelling of the brain) 3%, cardial disorders (miocardial infarct, arhythmias) 5%.

Complex diagnostics, based on detectiom anatomical lessions, perfusion reserve tests provides the ability to divide operations, lower the bloodless, time of anestesia, surgical trauma, or prevent miocardial infarction and stroke in patients, who had risc of these neurological and cardial disorders of operation on only carotid or coronary arteries. The modern surgical clinic with ability of diagnostics and surgical treatment can have good results of treatment of these high-risc patients.