Arif GÜCÜ, Derih AY, Faruk TOKTAŞ, Gündüz YÜMÜN, AYHAN UYSAL, Mehmet Tuğrul GÖNCÜ

Asemptomatik karotis arter darlıklı hastalarda öncelikli koroner arter bypass greft operasyonu sonrası nörolojik olay insidansı

Amaç: Karotis arter ve koroner arter hastalığının birlikteliği kardiyovasküler cerrahların karşılaştığı önemli patolojiler arasında yer almaktadır. Aynı anestezi ile her iki cerrahi girişimin birlikte yapılması veya karotis ya da koroner müdahaleden birinin önce diğerinin sonra yapılması cerrahi tedavi seçeneklerini oluşturmaktadır. Bu çalışmada, asemptomatik karotis darlığı olan koroner arter hastalarının öncelikli koroner arter bypass greftleme uygulamasında nörolojik olay gelişme insidansı geriye dönük olarak değerlendirilmiştir. Gereç ve Yöntem: Bursa Devlet Hastanesinde 2006 ve 2010 tarihleri arasında, koroner arter bypass greftleme operasyonu için yatırılan 258 hastanın 17'sinde asemptomatik orta derecede karotis darlığı, 8'inde ise asemptomatik kritik karotis darlığı saptanmıştır. Tüm olgular karotis darlığına müdahale edilmeden koroner arter bypass greftleme operasyonuna alınmıştır. Cerrahi strateji orta derecede hipotermi ve kardiyopulmoner bypass sırasında yüksek perfüzyon basıncı uygulanması, kross klemp ve kardiyopulmoner bypass zamanlarını kısa tutulmaya özen gösterilmesi ve intraoperatif ve erken postoperatif dönemde hipotansiyondan kaçınılmasıdır. Bulgular: Erken postoperatif dönemde mortalite ve/veya major strok olmadı. Kritik ve nonkritik karotis arter darlığı olan birer olguda postoperatif dönemde geçici iskemik atak bulguları saptandı ve bu olgular sekelsiz iyileşti. İstatistiksel olarak geçici iskemik atak gelişmesi açısından iki grup arasında fark saptanmadı (p=0,56). Sonuç: Asemptomatik karotis darlığı saptadığımız tüm olgularda öncelikli koroner arter bypass greftleme uygulamasının, uygun cerrahi strateji uygulandığı takdirde kabul edilebilir mortalite ve morbidite ile gerçekleştirilebileceğini kanaatindeyiz.

The incidence of neurologic event in patients with asymptomatic carotid artery stenosis after priority coronary artery bypass graft operation

Objective: The coexistence of carotid artery and coronary artery disease is one of the major pathologies for cardiovascular surgeons. In patients undergoing Coronary Artery Bypass Graft (CABG) with carotid artery stenosis, treatment strategies have still a lot of uncertainties. Carotid and coronary artery surgical treatment can be done as a single procedure, or one of them can be done first. In this retrospective study, we evaluated the incidence of cerebrovascular accident in the asymptomatic carotid artery stenosis cases who underwent coronary artery surgery. Materials and Methods: Between 2006 and 2010, 258 patients were admitted for coronary bypass surgery in Bursa State Hospital. Seventeen patients were asymptomatic moderate carotid stenosis cases, 8 patients were asymptomatic critical carotid stenosis cases. Preference CABG was applied to the all patients. Our surgical strategy included to have modarete hypothermia, high perfusion presure during the cardiopulmonary bypass (CPB), to try to be keep CPB and X-clamp time shortly and to avoid hypotension in the perioperative or postoperative period. Results: There was no mortality and no major stroke in the early postoperative period. In two patients, transient ischemic accident was observed in the early postoperative period and recovered without any sequel. Statistically no significant difference was found between the two groups for the development of transient ischemic accident (p=0,56). Conclusion: In patients with asymptomatic carotis stenosis, if proper surgical strategy is applied, CABG can be performed with acceptable mortality and morbidity.

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