"One-stop" hybrid operation of carotid stenting and coronary artery bypass grafting: A case report and literature review / 解放军医学杂志

ABSTRACT

Objective To improve the diagnosis and treatment of coronary heart disease with carotid stenosis, explore synchronous hybrid treatment for coronary heart disease with severe carotid stenosis and review of literature. Methods A case of "one-stop" carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) hybrid surgical treatment of coronary heart disease with severe carotid stenosis was reported in present paper. Searching the China National Knowledge Infrastructure (CNKI) and PubMed databases, several literatures were retrieved and analyzed to summarize the experience of diagnosis and treatment of coronary heart disease with severe carotid stenosis. Results A 64-year-old male patient was admitted to our hospital due to intermittent chest tightness for more than one month. Imaging examination, including coronary angiography, carotid ultrasound and cerebral vessel angiography, showed that severe coronary heart disease with bilateral carotid stenosis and obvious cerebral ischemia in the right brain hemisphere. Operation for right carotid artery was first performed under local anesthesia, and then the off-pump CABG was carried on under general anesthesia. Operation procedure was going well, and the recovery was good. The patient was followed up 3 months after operation, and there was no chest tightness and head-neck discomfort. Fourteen articles were obtained through database retrieval, and a total of 590 patients were reported including 427 male cases (72.4%) and 163 female cases (27.6%). All of them were treated at same stage with first CAS and sequential CABG. The interval between CAS and CABG was less than 24 hours. Findings indicated that postoperative stroke in 21 cases (3.5%), perioperative myocardial infarction in 11 cases (1.8%) and in-hospital death in 26 cases (4.4%). The follow-up results were satisfactory. Conclusion "One-stop" CAS and CABG hybrid treatment is one of good therapeutic options for patients with coronary heart disease and carotid stenosis, but this operation needs to be carried out in the hybrid operation room, and the technical requirements for the surgeons are relatively high.