頭蓋外脳血管病変を有するCABG 頸動脈血栓内膜摘除術との同時手術の適応と成績

摘要

The purpose of this study is to assess the clinical results of coronary artery bypass grafting (CABG) in patients with carotid artery disease, especially concomitant with carotid endarterectomy (CEA).Between April 1993 and April 2008, 77 patients (aged 69.5 + 7.1 years, 77.9% male) with carotid artery stenotic disease underwent CABG. Cerebral hemodynamics in all patients was examined with single photon emission computerized tomography (SPECT). Treatment course was decided after through diagnostic evaluation and strategic discussion with brain surgeons. Among these, 12 patients required CEA simultaneously, because both coronary and carotid artery diseases were too serious for safe staged operation.Hospital death occurred in 3 patients (3.9%). Two patients (2.6%) had postoperative stroke, but were discharged without neurological deterioration. In 12 patients receiving CABG and CEA simultaneously, there was no intraoperative stroke or hospital death. One patient had hyperperfusion syndrome after CEA, and required adequate rehabilitation exercise.CABG concomitant with CEA is an acceptable and feasible procedure in patients with significant coronary and carotid artery diseases. In order to improve surgical outcome of combined cases, it is important to prevent occurrence or aggravation of cerebral hyperperfusion syndrome.