Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

N. TORMA 1, V. SIHOTSKY 2, I.I. KOPOLOVETS 3, M. FRANKOVITSHOVA 2, F. SABOL 2, M. KUBIKOVA 2, P. STEFANIC 2

RESULTS OF SIMULTANEOUS OPERATIONS IN PATIENTS WITH ATHEROSCLEROTIC LESIONS OF CAROTID AND CORONARY ARTERIES

Vascular Center "IMEA "1, Kosice,
Center of Cardiovascular diseases "VUSCH", P.J. Safarik University, medical faculty 2, Kosice,
The Slovak Republic
HSEE "Uzhhorod National University", medical faculty 3, Uzhhorod,
Ukraine

Objectives. To evaluate the results of simultaneous operations in patients with atherosclerotic lesions of coronary and carotic arteries and an algorithm has been specifically developed for selection patients.
Method. The results of surgical treatment of 78 patients are presented. The patients were divided into 3 groups according to the patients clinical findings and diagnostic outcomes: I group (38 patients) simultaneous operation (carotid endarterectomy and coronary artery bypass grafting (CABG)); II group (16 patients) the first stage carotid endarterectomy, the second stage CABG; III group (24 patients) the first stage CABG, the second stage carotid endarterectomy.
Results. In comparing the immediate results of simultaneous and staged surgical treatment of atherosclerotic stenosis of the internal carotid artery (ICA) and myocardial revascularization no reliable difference has been established (<0,05). Cerebral blood flow disturbance was observed in the 1st group in 2 patients (5,2%), 1 (2,6%) patient died. To improve the results of the treatment of combined coronary and cerebrovascular pathology an algorithm for diagnosis and treatment has been developed. According to the presented algorithm a simultaneous surgery should be performed only for select groups of patients with unstable angina pectoris in patients with symptomatic ICA stenosis more than 60%; asymptomatic ICA stenosis of 70% and greater in case of contralateral ICA occlusion; asymptomatic ICA stenosis of 70% with high embologenic lesion; a two-sided asymptomatic ICA stenosis greater than 70%. In case of severe coronary bed lesion the patients received combined operations coronary artery bypass grafting (CABG) involving carotid endarterectomy (CE) as the second stage in the remote period. In case of stable angina pectoris in patients with symptomatic ICA stenosis of 60% and greater is recommended to perform two stage procedures: CE as the first stage and the second CABG.
Conclusion. In case of combined lesion of coronary and carotid arteries a simultaneous intervention is certainly indicated to appropriately selected patients with unstable angina pectoris (symptomatic ICA stenosis of 60% and greater) and asymptomatic severe carotid artery stenosis. The immediate and delayed postoperative outcomes of simultaneous operations were found to be satisfactory and made up 92,2%.

Keywords: diagnostics, angina pectoris, carotid stenosis, carotid endarterectomy, coronary artery bypass grafting, simultaneous operation, algorithm
p. 171-175 of the original issue
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Address for correspondence:
88000, Ukraina, g. Uzhgorod,
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GVUZ "Uzhgorodskiy natsionalnyiy universitet",
meditsinskiy fakultet,
tel. mob: 380505588211,
e-mail: i.kopolovets@gmail.com,
Kopolovets Ivan Ivanovich
Information about the authors:
Torma N., PhD, vascular surgeon "IMEA ", Kosice, the Slovak Republic
Sihotsky V., PhD, Deputy Head on pedagogical affairs of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.
Kopolovets I.I., PhD, a researcher of HSEE "Uzhhorod National University", medical faculty, Uzhhorod, Ukraine.
Frankovitshova M., PhD, professor, a head of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.
Sabol V, PhD, a director of the Center of Cardiovascular diseases "VUSCH", P.J.Safarik University, medical faculty, Kosice.
Kubikova M., PhD, a head of the vascular surgery department, P.J.Safarik University, medical faculty, Kosice.
Stefanic P., a post-graduate student of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.
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