Staged versus combined approaches for concomitant carotid and coronary artery disease. perioperative morbidity and mortality

There is a continuing controversy about the management of patients with concomitant occlusive disease of the coronary and carotid arteries. The options vary from combined to staged approach. The efficacy and safety of each method can be measured, essentially, by the global mortality, and morbidity. 33 of 1490 [2.21%] consecutive patients who were referred for isolated CABG were found to have significant carotid disease and underwent isolated coronary artery bypass graft [CABG] and carotid endarterectomy [CEA]. 23 patients had the staged approach [CEA, and subsequently CABG], while 10 patients had the combined approach [simultaneous CEA and CABG]. For these high-risk patients, there were 3 in-hospital mortalities, 1 patient in staged group [4.3%], and 2 patients [20%] in the combined group. While no patients in the staged group had stroke, 2 cases of disabling stroke were encountered in the combined group. One of these 2 cases was disabling stroke and death [Stroke related mortality]. Both patients who experienced postoperative stroke had a previous history of CVA. No patients in either group had Perioperative myocardial infarction. Staged approach is a good and safe alternative surgical option for patients with concomitant carotid and coronary artery disease. Our current approach is to favor staged carotid and coronary surgery, based on our operative experience and our Risk analyses [lower perioperative mortality and morbidity rates]. A rapid staged procedure may be a safe option to decrease the hospital stay

Is it possible to avoid postoperative haematoma as a complication of intracranial surgery?

Postoperative intracranial haematoma is a serious complication of intracranial surgery with a mortality rate of around 30%. There have been reports implicating abrupt rises of blood pressure during the last stages or immediately after the procedure, in the production of the clot. This prospective study examined this hypothesis. Over 2[1/2] A years 100 consecutive patients underwent craniotomy [in the Neurosurgical Departement of Zagazig University Hospitals].Under a strict anaethesiological protocol based on deep opioid analgesia which virtually elimenated any acute elevations of the arterial pressure during and immediately after craniotomy. Emergence from anaesthesia was delayed for an average 1[1/2]-2h following the procedure. Postoperative CT was obtained in every patients. There have been no cases of postoperative clot formation in this series of patients. The result of the study suggest that postoperative haematoma is probably an avoidable complication of intracranial surgery