頚動脈内膜剥離術と冠動脈バイパス術との同時手術　　Ｏｆｆ　ｐｕｍｐ　ＣＡＢＧとの同時手術の有用性:―Off pump CABGとの同時手術の有用性―

スポンサーリンク

概要

• 論文の詳細を見る

• The role of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in patients with severe carotid artery stenosis and concurrent coronary artery stenosis is still controversial. However, patients with severe carotid stenosis experience a higher rate of perioperative cerebrovascular events, compared with those without serious stenosis. Simultaneous operations have been performed in our institute since 1999, and we report the efficacy of combined CEA and CABG especially without cardiopulmonary bypass (off-pump CABG=OPCABG).Five combined oprations were performed between December 1999 and March 2001. All patients had multiple coronary lesions with more than 75% unilateral carotid stenosis. One patient had contralateral internal carotid occlusion and 1 had the tandem lesions at the distal internal carotid artery and middle cerebral artery concomitantly. Four were asymptomatic neurologically and 1 was symptomatic. Cerebral hemodynamics in all patients was examined with single photon emission CT (SPECT) and cerebral angiography, but none of them demonstrated hemodynamic compromise before operation. Three patients were treated with CEA and off-pump CABG, and 2 were CEA and CABG with cardiopulmonary bypass. CEA preceded CABG, but the saphenous veins were taken in the course of endarterectomy. After CEA, the operative field was turned over to the cardiovascular team with the cervical wound being opened. Subsequently the cardiovascular team performed CABG with off-pump or pump. Off-pump CABG brought less blood loss from the cervical wound for the minimum anticoagulant than CABG with cardiopulmonary bypass.No cardiac event occurred perioperatively, but 1 patient with transient neurological ischemic attack with tandem lesions had a transient neurological ischemic attack during hemodialysis on the day after the operation. All the patients were discharged without neurological deterioration.Preoperative screening to the supra-aortic artery is helpful for evaluating the presence of carotid or intracranial vessels in patients undergoing CABG, and cerebral blood flow studies to clarify the cerebral hemodynamics are important for patients with both carotid and coronary occlusive diseases. It is still not clear what patients are suitable for the combined operation, but all the patients with high grade carotid stenosis can undergo the combined operation with off-pump CABG with the benefits of low morbidity and patient convenience.

• 一般社団法人 日本脳卒中の外科学会の論文

一般社団法人 日本脳卒中の外科学会 | 論文

• 頸部内頸動脈のｎｅａｒ　ｏｃｃｌｕｓｉｏｎに対するＳＴＡ‐ＭＣＡ吻合術
• 未破裂脳動脈瘤の外科手術の合併症とその対策―慢性硬膜下血腫および後頭蓋窩出血の発生予防―:―慢性硬膜下血腫および後頭蓋窩出血の発生予防―
• 周術期管理指針に基づいたもやもや病に対する血行再建術:―急性期脳血流評価と予防的降圧の効果と限界―
• 未破裂脳動脈瘤クリッピング術の治療成績‐脳動脈瘤手術初心者の経験‐:―脳動脈瘤手術初心者の経験―
• 脳底動脈上小脳動脈分岐部動脈りゅう５８手術例の検討

もっと見る

スポンサーリンク