Mehmet BALKANAY, Berk ÖZKAYNAK, Altuğ TUNCER, Cüneyt KELEŞ, Mehmet Erdem TOKER, Ercan EREN, Gökhan İPEK, Mustafa GÜLER

Simultaneous carotid endarterectomy and coronary revascularization using moderate hypothermia in patients with bilateral carotid disease and coronary artery disease

Amaç: Karotis ve koroner arter hastalığının bir arada bulunduğu olgularda uygun cerrahi strateji halen tartışmalıdır. Bu çalışmada, sistemik hipotermi altında eşzamanlı koroner arter revaskülarizasyonu ve karotis endarterektomisi uygulamasının güvenliği ve etkinliği araştırıldı. Çalışma planı: Çalışmada iki taraflı karotis arter hastalığı ve koroner arter hastalığı olan 15 olgu (11 erkek, 4 kadın; ort. yaş 64; dağılım 55-72) geriye dönük olarak değerlendirildi. Dokuz hastada iki taraflı %70 ve üzerinde karotis darlığı ve karşı tarafta tıkanıklık, altı hastada ise %80-99 iki taraflı karotis arter darlığı vardı. Tüm hastalara orta derecede (25 ºC) sistemik hipotermi altında karotis endarterektomisi uygulandı. Koroner arter revaskülarizasyonu soğuma ve ısınma periyodları sırasında yapıldı. Ortalama izlem süresi 26.2±8.3 ay (dağılım 12-41 ay) idi.Bulgular: Hastane içi ölüm olmadı. Ortalama greft sayısı 2.7±0.7 idi. Ortalama karotis oklüzyon zamanı ve krosklemp zamanı sırasıyla 14.5±0.7 ve 104±8.2 dakika bulundu. Hastanede kalış süresi ortalama 7.6±0.8 gündü. Ameliyat sonrası izlem süresince hiçbir hastada inme ve ölüme rastlanmadı, karşı taraf karotis endarterektomisi gerekmedi.Sonuç: İki taraflı karotis hastalığı ve koroner arter hastalığının bir arada bulunduğu olgularda serebral koruma için sistemik hipotermi altında eşzamanlı koroner arter revaskülarizasyonu ve karotis endarterektomisi uygulaması güvenli ve etkili bir yöntemdir.

İki taraflı karotis ve koroner arter hastalığında orta derecede sistemik hipotermi uygulanarak eşzamanlı karotis arter endarterektomisi ve koroner revaskülarizasyonu

Background: The appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. This study was designed to investigate the safety and effectiveness of simultaneous applications of coronary revascularization and carotid endarterectomy under systemic hypothermia. Methods: We retrospectively evaluated 15 patients (11 males, 4 females; mean age 64 years; range 55 to 72 years) with coronary artery disease and bilateral carotid artery stenosis. Nine patients had bilateral carotid artery disease with more than or equal to 70% stenosis and contralateral occlusion, and six patients had bilateral stenosis ranging between 80% and 99%. All the patients underwent carotid endarterectomy under moderate (25 ºC) systemic hypothermia. Coronary revascularization was performed during the periods of cooling and rewarming. The mean follow-up period was 26.2±8.3 months (range 12 to 41 months).Results: No hospital mortality was seen. The mean number of grafts used was 2.7±0.7. The mean times of carotid occlusion and cross-clamping were 14.5±0.7 minutes and 104±8.2 minutes, respectively. The mean hospital stay was 7.6±0.8 days. None of the patients developed stroke or death or required contralateral carotid endarterectomy during the follow- up period.Conclusion: Simultaneous coronary artery bypass grafting and carotid endarterectomy using moderate systemic hypothermia for cerebral protection is a safe and effective procedure for patients with coexisting coronary artery disease and significant bilateral carotid artery occlusive disease.

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