Novosti
|
This journal is indexed in Scopus |
|---|
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 ÑÑ"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 patient’s 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 (ð<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%.
- Gabr³ºlian AV, N³kul'n³kov P², Ratushniuk AV. ta ³n. Simul'tann³ operativn³ vtruchannia ³z ³shem³chnoiu khvoroboiu sertsia ta mul'tifokal'nogo aterosklerozu [Simultaneous surgery for coronary heart disease and multifocal atherosclerosis]. Arkh Kl³n Med. 2014:2(20):19-21. Available from: http://issuu.com/glvisnyk.if.ua/docs/akm__2_2014.
- Cherniavskii AM, Karas'kov AM, Mironenko SP, Kovliakov VA. Khirurgicheskoe lechenie mul'tifokal'nogo ateroskleroze [Surgical treatment for multifocal atherosclerosis]. Biulleten' SO RAMN. 2006;2 (120):126-31.
- Bendov DV, Naimushin AV, Bakanov AIu, Bakanov AIu. Odnomomentnaia karotidnaia endarterektomiia i koronarnoe shuntirovanie u patsientov s dvustoronnim porazheniem sonnikh arterii [Simultaneous carotid endarterectomy and coronary artery bypass grafting in patients with bilateral carotid arteries]. Arterial Gipertenziia. 2009;15(4):502-506.
- Rusin V², Korsak VV, Butsko ªS, Demidiuk DV, Borsenko M². Vib³r kh³rurg³chno¿ taktiki pri poºdnanikh urazhenniakh v³ntsevikh arter³i ta arter³i dugi aorti [The choice of surgical treatment of combined lesions of the coronary arteries and aortic arch arteries]. Nauk V³sn Uzhgorod Un³versitetu Ser³ia Meditsina. 2012;2 (44):106-10.
- Venkatachalam S, Gray BH, Mukherjee D, Shishehbor MH.Contemporary management of concomitant carotid and coronary artery disease. Heart. 2011 Feb;97(3):175-80. doi: 10.1136/hrt.2010.203612.
- Naylor AR.Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease? J Cardiovasc Surg (Torino). 2009 Feb;50(1):71-81.
- Santos A, Washington C, Rahbar R, Benckart D, Muluk S. Results of staged carotid endarterectomy and coronary artery bypass graft in patients with severe carotid and coronary disease. Ann Vasc Surg. 2012 Jan;26(1):102-6. doi: 10.1016/j.avsg.2011.10.002
88000, Ukraina, g. Uzhgorod,
ul. Universitetskaya, d. 10,
GVUZ "Uzhgorodskiy natsionalnyiy universitet",
meditsinskiy fakultet,
tel. mob: 380505588211,
e-mail: i.kopolovets@gmail.com,
Kopolovets Ivan Ivanovich
Torma N., PhD, vascular surgeon "IMEA ÑÑ", 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.
Article in the .pdf format
