Tactics of cardiosurgical patients with concomitant stenotic lesions of carotid arteries
Abstract
The combination of cardiac surgery and carotid artery disease requires more attention and understanding in tactics for the management of such patients. Treatment of cardiac surgery with the use of artificial blood circulation or the technique of intervention on the working heart, in these patients, without correction of damage to the carotid arteries, is dangerous and can lead to a stroke. In patients with asymptomatic stenosis of carotid arteries after cardiac surgery, the incidence of stroke is 3%, due to improper blood supply to the brain. The combination of carotid stenosis with cardiac surgery causes a number of questions regarding the definition of optimal tactics for the management of such patients. A group of patients was 18 patients who had a combination of cardiac surgery with different variants of hemodynamic and significant narrowing of the carotid arteries. All patients were examined and surgically treated. Carotid endarterectomy was performed in all cases, but it was carried out at once or in stages, depending on the severity of the cardiological pathology. A special approach is to choose disaggregation and anticoagulation therapy. In the early postoperative period, all patients were assigned low molecular weight heparins and Clopidogrel 75 mg. In connection with implantation of artificial valves, Warfarin was prescribed (target value of MNO 2.5-3.0).
References
2. Quality of life after carotid endarterectomy: a review of the literature / M. Chabowski, A. Grzebien, A. Ziomek et al. // Acta Neurol Belg. – 2017. – Vol. 117. – P. 829–835.
3. Coronary angiography in 506 patients with extracranial cerebrovascular disease / Hertzer N. R., Young J. R., Beven E. G. et al. // Arch Intern Med. – 1985. – Vol. 145. – P. 849–52.
4. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques / Liapis C. D., Bell P. R., Mikhailidis D. et al. // Eur J Vasc Endovasc Surg. – 2009. – Vol. 37. – P. 1–19.
5. Preoperative noninvasive coronary risk stratification in candidates for carotid endarterectomy / Urbinati S., Di Pasquale G. et al. // Stroke. – 1994. – Vol. 25. – P. 2022–7.
6. Asymptomatic carotid artery stenosis and stroke in patients undergoing cardiopulmonary bypass / Schwartz L. B., Bridgman A. H., Kieffer R. W. et al. // J Vasc Surg. – 1995. – Vol. 21. – P. 146–53.
7. Comparison of Trends and In-Hospital Outcomes of Concurrent Carotid Artery Revascularization and Coronary Artery Bypass Graft Surgery: The United States Experience 2004 to 2012 / Feldman D. N., Swaminathan R. V., Geleris J. D. et al. // JACC Cardiovasc Interv. – 2017. – Vol. 10. – P. 286–298.
8. Meta-analysis and meta-regression analysis of the associations between sex and the operative outcomes of carotid endarterectomy / T. Luebke, J. Brunkwall // BMC Cardiovasc Disord. – 2015. – Vol. 15. – P. 32.
9. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?/ P. Ogutu, R. Werner, F. Oertel et al. // Interact Cardiovasc Thorac Surg. – 2014. – Vol. 18. – P. 511–518.
10. The role of combined carotid endarterectomy and coronary artery bypass grafting in the era of carotid stenting in view of long-term results / E. Levy, D. Yakubovitch, E. Rudis et al. // Interact Cardiovasc Thorac Surg. – 2012. – Vol. 15. – P. 984–988.
11. Short- and Long-Term Major Cardiovascular Adverse Events in Carotid Artery Interventions: A Nationwide Population-Based Cohort Study in Taiwan / Ming-Lung Tsai, Chun-Tai Mao, Dong-Yi Chen et al. // PLoS One. – 2015. – Vol. 10.
