The Choice of the Approach to Off-Pump Surgical Treatment for Combined Occlusive and Stenotic Lesions of Brachiocephalic and Coronary Arteries
Summary. The heart and brain are the most dependent organs on the violation of blood flow. In fact, combined atherosclerotic lesions of the carotid and coronary arteries are found in 5.9 to 22% of cardiac patients.
Objective. To improve the results of treatment for combined occlusive and stenotic lesions brachiocephalic and coronary arteries by designing the surgical approach for the patients with multifocal atherosclerosis.
Materials and methods. The results of surgical treatment of 62 patients with combined atherosclerotic occlusion-stenotic lesions of the carotid and coronary arteries were analyzed. Depending on the surgical approach used, patients were divided into two groups: one-step (35) on two vascular pools and stage operations (27). The survey protocol included general clinical and specific methods of heart and brain testing.
Results and discussion. Satisfactory results of surgical treatment of patients with multifocal atherosclerosis with coronary and brachiocephalic vessels were obtained in 61 (98.4%) patients. Within 12 months after surgical treatment, the number of unsatisfactory results increased to 4 cases, however, this was not associated with the chosen surgical treatment method, but was due to the progression of the underlying disease (atherosclerosis) or complication of the concurrent pathology (hypertension), where acute disorders were recorded cerebral circulation. The algorithm of diagnostics is developed and the criteria of decision making are determined, the basic indications concerning the choice of approach of surgical treatment this category patients. It has been established that one step surgeries are recommended for the patients with critical lesions of coronary arteries combined with carotid artery pathology, in particular, unstable atherosclerotic plaques and low perfusion reserve of the brain and the myocardium.
Conclusion. By using the proposed clinical decision making algorithm, every patient may benefit from the choice of the best method of either one-step or staged surgical treatment, whichever is more suitable.
One-step surgeries are recommended for the patients with circulatory decompensation in both affected arterial territories. Staged surgical treatment may be used in patients with stable progression of coronary heart disease, without clinically significant neurological disorders.
- Belov YuV, Lysenko AV, Komarov RN, Stonogin AV. [The results of off-pump coronary artery bypass grafting in patients with left main coronary artery stenosis and equivalent lesion of left main coronary artery]. Kardiologiya i serdechno-sosudistaya khirurgiya. 2016;9(5):18–22. Russian. https://doi.org/10.17116/kardio20169518-22
- .Vinychuk SM, Fartushna OYe. [Epidemiology of transient ischemic attacks in the structure of acute cerebrovascular disorders in Ukraine and in other countries]. International neurological journal. 2017;(5):105–11. Ukrainian. https://doi.org/10.22141/2224-0718.104.22.1687.110863
- Gordeev IG, Lebedeva AY, Volov NA, Grishina IS, Semiokhina AS. [Surgical and Endovascular Revascularization of Myocardium in Multivessel Disease]. Russian Journal of Cardiology. 2016;(2):90–4. Russian. https://doi.org/10.15829/1560-4071-2016-2-90-94
- .Volkov AM, Khubulava GG, Pajvin AA, Yurchenko DL, Kravchuk VN, Lyubimov AI. [Specific Features of the Technique of Performing Coronary Bypass Operations on the Beating Heart]. Grekov’s Bulletin of Surgery. 2012;71(2):11–6. Russian.
- Kuznetsov MS, Kozlov BN, Nasrashvili GG, Panfilov DS, Plotnikov MP, Andiyanova AV, Shipulin VM. [Analysis of the Surgical Outcomes of Combined Athersclerotic Lesions of Carotid and Coronary Arteries]. Complex Issues of Cardiovascular Diseases. 2016;(3):35–42. Russian.
- Mishalov VG, Koshevskyi YuI, Cherniak VA, Seliuk VM. [Principles of Diagnosis and Comprehensive Treatment of Patients with Pathology of Brachiocephalic Arteries Combined With Multifocal Atherosclerosis]. Ukr. balneolog. zhurnal. 2007;(2/3):84–5. Ukrainian.
- Mukshymenko TV. [Morbidity and Death Rate of Population of Ukraine: Dynamics and Regional Aspect]. Medsestrynstvo. 2014;(4):23–8. Ukrainian.
- Alexandrov AV, Needleman L. Carotid artery stenosis: making complex assessments of a simple problem or simplifying approach to a complex disease? Stroke. 2012 Mar;43(3):627–8. https://doi.org/10.1161/STROKEAHA.111.645457
- Ali IM. Staged carotid and coronary surgery for concomitant carotid and coronary artery disease. Eur J Cardiothorac Surg. 2002 Aug;22(2):327. https://doi.org/10.1016/s1010-7940(02)00305-6
- Raja SG. Two decades of off-pump coronary artery bypass surgery: Harefield experience. J Thorac Dis. 2016 Nov;8(Suppl 10):S824–8. https://doi.org/10.21037/jtd.2016.10.103
- Barrera JG, Rojas KE, Balestrini C, Espinel C, Figueredo A, Saaibi JF, et al. Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis. J Vasc Surg. 2013 Feb;57(2 Suppl):58S–63S. https://doi.org/10.1016/j.jvs.2012.06.116
- Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017 Mar 7;135(10):e146–e603. https://doi.org/10.1161/CIR.0000000000000485
- Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Rayner M, Townsend N, et al. European Cardiovascular Disease Statistics 2017 [Internet]. 2017 Feb [cited 2018 Sep 18]. Available from: http://www.ehnheart.org/images/CVD-statistics-report-August-2017.pdf