Staged coronary artery bypass grafting after percutaneous angioplasty for intracranial vascular stenosis

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 122; no. 3; pp. 608 - 610
• Main Authors: Kihara, Shin'ichiro, Shimakura, Tadayuki, Tanaka, Satoshi A., Hanayama, Naoji, Saito, Norihiko, Hirasawa, Yujiro, Sugawara, Yuji, Maeba, Satoru, Yoshizumi, Hideyuki
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.09.2001; AATS/WTSA; Elsevier
• Subjects: Aged; Angiography, Digital Subtraction; Angioplasty, Balloon - methods; Biological and medical sciences; Brain Ischemia - classification; Brain Ischemia - complications; Brain Ischemia - diagnosis; Brain Ischemia - therapy; Cerebral Angiography; Cerebral Arteries; Constriction, Pathologic; Coronary Artery Bypass - methods; Coronary Disease - complications; Coronary Disease - surgery; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Patient Selection; Risk Factors; Severity of Illness Index; Stents; Stroke - etiology; Stroke - prevention & control; Stroke Volume; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; Cuffed tube; Stenosis; Cardiovascular disease; Cerebral artery; Arterial disease; Vascular disease; Prevention; Aortocoronary; Surgery; Complication; Graft; Cerebrovascular disease; Human; Intracranial; Nervous system diseases; Stroke; Treatment efficiency; Instrumentation therapy; Instrumental dilatation; Coronary heart disease; Artery; Cerebral disorder; Concomitant disease; Treatment; Bypass; Central nervous system disease; Comparative study
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2001.115159

Objective: Cerebrovascular disease is commonly associated with coronary artery disease and is a major risk factor for cardiac surgery. Concomitant coronary artery bypass grafting and carotid endarterectomy may reduce the risk of stroke; however, this staged operation is effective only for extracranial lesions. The strategy for on-pump coronary artery bypass grafting for patients with intracranial vascular stenosis is still controversial. Methods: The subjects were 157 consecutive candidates for coronary artery bypass grafting who underwent computed tomography and digital subtraction cerebral angiography preoperatively to check for cerebrovascular disease. Additional single-photon emission computed tomography was performed to evaluate cerebral ischemia, according to the neurologist's request. Patients with diffuse intracranial vascular stenosis impossible to treat with percutaneous transluminal angioplasty underwent off-pump coronary artery bypass grafting. Patients with a circumflex coronary artery lesion first underwent percutaneous transluminal angioplasty for cerebral vascular stenosis followed by secondary on-pump coronary artery bypass grafting. Results: Three patients were selected for staged operations. Percutaneous transluminal angioplasty was performed for 4 intracranial stenotic lesions. All lesions were dilated successfully, and no complications developed during or after the procedure. All patients tolerated staged coronary artery bypass grafting and were extubated within 1 day without any mental disturbance. No further neurologic complication occurred, and computed tomography performed postoperatively revealed no significant changes. Conclusion: Staged on-pump coronary bypass after percutaneous transluminal angioplasty for cerebrovascular disease may reduce the risk of stroke during cardiopulmonary bypass, and it is useful especially in patients with intracranial cerebrovascular disease.