Ali PARLAR, Ayşen AKSÖYEK, Levent ALTIN, Kerem YAY, Ferit ÇİÇEKÇİOĞLU, Salih Fehmi KATIRCIOĞLU

Successful coronary artery bypass grafting in a patient with bilateral internal carotid artery occlusion: A case report

Cerrahi gerektiren koroner arter hastalığı ve iki taraflı tam karotis arter tıkanıklığı olan hastalarda en iyi yaklaşım konusu tartışmalıdır. Altmış bir yaşında erkek hasta kararsız anjina pektoris ile kliniğimize başvurdu. Tıbbi öyküsünde 11 yıl önce geçirilmiş serebrovasküler olay vardı. Fizik muayenede, dizartri ve sağ üst ekstremitede monoparezi vardı. Koroner ve karotis anjiyografisinde kritik koroner arter darlığı ve iki taraflı internal karotis arterlerde tam tıkanıklık ve sağ vertebral arterde tam tıkanıklık, sol proksimal vertebral arterde %40 darlık vardı. İntravenöz fentanil genel anestezisini takiben, düşük doz heparin uygulandı ve koroner arter bypass greftleme (KABG) atan kalp tekniğiyle yapıldı. Ameliyat sırasında serebral kan akımını korumak için sistolik kan basıncı 120 mmHg’nın üzerinde tutuldu. Ameliyat sonrası seyir sorunsuzdu ve hasta 7. günde taburcu edildi. Eğer serebrovasküler açıdan yüksek riskli olan hastalarda KABG zorunlu ise, inme riskini azaltmak için atan kalpte KABG gerçekleştirilebilir.

İki taraflı internal karotis arter tıkanıklığı olan hastada başarılı koroner arter bypass greftleme: Olgu sunumu

The best management regimen for patients with coronary artery disease requiring surgery and bilateral total internal carotid artery occlusion remains controversial. A 61-year-old male patient presented with unstable angina pectoris. His medical history revealed that he had a cerebrovascular accident 11 years ago. On physical examination, he had dysarthria and monoparesis on the right upper extremity. Coronary and carotid angiography revealed critical coronary artery stenosis and total occlusion of bilateral internal carotid arteries, total occlusion of the right vertebral artery and 40% stenosis of the left proximal vertebral artery. After general intravenous fentanyl anesthesia, low dose heparin was administered, and coronary artery bypass grafting (CABG) was performed under off-pump beating heart condition. Systolic blood pressure was maintained above 120 mmHg to preserve cerebral blood flow during the operation. The postoperative course was uneventful and the patient was discharged in the 7th day postoperatively. If CABG is mandatory in patients having high cerebrovascular risk, off-pump CABG could be performed to reduce the stroke risk.

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