Coronary Artery Bypass Surgery Combined With Carotid Stenosis Management Strategy (A Report Of 19 Cases)

Objective:To evaluate the clinical efficacy of carotid artery and coronary revascularization in the treatment of coronary heart disease complicated with carotid stenosis,and to summarize the relevant treatment experience.Method: Retrospective analysis of clinical data of 19 patients undergoing carotid and coronary revascularization surgery in our hospital from January 2016 to September 2018,There were 16 males(84.2%)and 3 females(15.8%),aged 51-70 years,with an average of 63.58±4.92 years old.Among them,7 patients underwent concurrent CEA+ OPCAB surgery,11 patients underwent CAS+ OPCAB surgery,and 1 patient underwent CEA+ OPCAB surgery.The postoperative ventilator use time,ICU stay time,cumulative postoperative drainage volume,input red blood cell volume,and hospitalization days were recorded for each patient.The CABG internal mammary artery and saphenous vein use,the number of bypass grafts,and postoperative complications were recorded.CAS complicated with cardiovascular events,surgical interval cardiovascular events.Patients were followed up for stroke,new myocardial infarction,and emerging neuropsychiatric symptoms.Result: All patients had no stroke,death,or myocardial infarction during the perioperative period.7 patients with concurrent CEA+ OPCAB,ventilator use time 10-20 hours,average 15.29±3.04 hours,ICU stay time 55-206 hours,average 89.29±49.78 hours,postoperative drainage volume 900-2037 ml,average 1306.57±411.29 Ml,the amount of red blood cells used after surgery was 2-20 U,with an average of 5.75±5.70 U,and the hospital stay was 22-35 days,with an average of 29.14±4.42 days.11 patients with CAS+ OPCAB in advance,the interval between CAS and OPCAB was 6-16 days,with an average of 10.82±3.04 days.In the case of CAS,there was a case of low heart rate,2 cases of blood pressure drop,and 1 case of short-term chest tightness and self-remission.In the two surgical intervals,3 patients developed chest discomfort,shortness of breath and other discomforts,and 2 patients had angina pectoris.The ventilator used time was 5-20 hours,with an average of 10.45±4.34 hours.The ICU stay time was 36-100 hours,with an average of 61.73±21.84 hours.The postoperative drainage volume was 720-2600 ml,with an average of 1223.64±544.76 ml.The postoperative red blood cell usage was 0-20 U,with an average of 4.36±5.83 U,and hospital stays of 26-47 days,with an average of 40.82 ± 6.12 days.One patient underwent CEA+ OPCAB in advance.The interval between CAS and OPCAB was 18 days,and chest tightness occurred in the two surgical intervals.In OPCAB,there were 76 distal anastomosis,3.79 ± 0.54 per case.Among them,18 were bridged with the left internal mammary artery(LIMA)and 57 with the saphenous vein.19 patients were followed up,the follow-up rate was 100%,and the follow-up time was 20.84 ±9.82 months.There were no new strokes,no myocardial infarction,and no new neuropsychiatric symptoms.Seven of the patients with neuropsychiatric symptoms before surgery had a conscious improvement,and 5 patients had no significant changes,and patients with asymptomatic aggravation.Conclusion:1.OPCABG combined with carotid revascularization is safe and feasible,and can significantly reduce the incidence of postoperative stroke.2.During the same period,CEA+ OPCABG has large surgical trauma and is suitable for patients with unstable coronary heart disease.3.CAS+ OPCABG in advance,long hospital stay,due to CAS waiting for OPCAPG period,cardiovascular and cerebrovascular events may occur,suitable for patients with stable coronary heart disease.4.Principles of carotid artery treatment: symptomatic carotid stenosis > 50%,asymptomatic carotid stenosis >70%;bilateral carotid stenosis,priority treatment of symptom side,if asymptomatic stenosis,priority treatment of severe stenosis.