Сочетанное атеросклеротическое поражение сонных и коронарных артерий: выбор хирургической тактики с учетом оценки функциональных резервов головного мозга

Abstract

Purpose. To develop and implement into clinical practice the algorithm of surgical tactics for patients with combined atherosclerotic lesion of coronary and carotid arteries basing on identification of functional reserve of myocardial and cerebral perfusion. Materials and methods. 68 patients with combined atherosclerotic lesion of coronary and carotid arteries were enrolled into the study. They were examined for reserved capabilities of their myocardium and cerebrum. Basing on the obtained results the patients were allocated into two groups: group 1 (n = 28) the patients who were subjected to simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) and group 2 (n = 40) – those on which the procedure of CEA was performed as the first stage and CABG as the second. Results. In the 1st group patients mean time of carotid artery clamping was 30,7 ± 6,1 min. Mean cardio pulmonary bypass (CBP) time during CABG comprised 50 ± 12,6 min. In 4 of the patients (14,2 %) clinical signs of encephalopathy were noticed. In one case (3,6 %) from this group acute cerebral blood flow disturbance was registered on a collateral side of CEA. Mean hospital stay for the group with simultaneous surgical treatment was 28,2 ± 4,7 days. Mean CA clamping time in the 2nd patient group was 30,2 ± 5,2 min and mean time on CPB during CABG was 57 ± 15,6 min. Acute myocardial infarction (MI) was verified in one patient (2,5 %) in the early postoperative period after CABG as the 2nd stage. Clinical signs of encephalopathy were registered in 3 (7,5 %) patients. Mean hospital stay for the 2nd group patients comprised 42,3 ± 5,1 days. Conclusion. Simultaneous surgeries are beneficial for the patients with lowered reserve of both coronary and cerebral blood flows. Risk of cerebral and cardiac postoperative complications is comparable with the outcomes after stage by stage surgeries, thus shortening patients’ hospital stay. Hypoxic test results are another criterion for making decision about placement of an intraarterial shunt. This makes the time for the main stage of CEA shorter and lets avoid extra possible complications in the early postoperative period.