The Prevalence and Distribution of Occlusive Lesions of the Cerebral Arteries in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Intracranial cerebral atherosclerosis is a significant predictor of stroke after coronary artery bypass grafting (CABG). However, there is limited information on intracranial occlusive lesions in patients undergoing CABG. The purpose of the study was to elucidate the precise prevalence and distribution of occlusive lesions of the extracranial and intracranial arteries in patients undergoing CABG. Between 2009 and 2016, 205 patients underwent preoperative magnetic resonance angiography and elective CABG. The prevalence and the distribution of occlusive lesions were retrospectively examined by preoperative magnetic resonance angiography. Association between postoperative central nervous system (CNS) complications and the occlusive lesions was analyzed. Fifty-six patients (27.3%) and 60 patients (29.3%) had occlusive lesions of the extracranial and intracranial arteries, respectively. Twenty-eight patients (13.7%) had both extracranial and intracranial occlusive lesions. Thirty-one (15.1%) and 45 (22.0%) patients had severe stenosis or occlusion of the extracranial and intracranial arteries, respectively. The intracranial internal carotid artery was the most commonly affected intracranial artery (60 vessels; 62.5%), followed by the middle cerebral arteries (20 vessels; 20.8%). Sixteen patients (7.8%) suffered from postoperative CNS complications, including 2 permanent strokes. The etiology of the stroke was attributable to a predefined intracranial lesion in 1 patient. In multivariate analysis, the presence of intracranial occlusive lesions was found to have an independent association with the development of CNS complications (odds ratio 4.05; 95% confidence interval 1.13-14.6). The prevalence of intracranial occlusive lesions was higher than that of extracranial lesions in patients undergoing CABG. There was a solid trend toward the anterior distribution of the intracranial occlusive lesions.

Anomalous Right Coronary Artery Arising from the Left Sinus of Valsalva in a Young Athlete.

Cardiac events associated with congenital coronary abnormalities are rare but potentially life-threatening in a young population. Most of these patients are not diagnosed before their initial cardiac event. Amongst such coronary artery anomalies, sudden death is frequently seen in an anomalous origination of a coronary artery from the opposite sinus. We herein present the case of a patient who presented with sudden cardiac arrest associated with an anomalous right coronary artery originating from the left sinus of Valsalva. Surgical treatment was selected because there was evidence of reversible ischemia based on the findings of a stress test.

[Review of chemoradiotherapy followed by surgical resection in locally advanced non-small-cell lung cancer].

Chemoradiotherapy is recommended for locally advanced non-small-cell lung cancer(NSCLC). However, the overall median survival time remains poor(<20 months). We evaluated the outcome and complications of chemoradiotherapy, followed by surgical resection, in locally advanced NSCLC. Eight patients(7 men and 1 woman; median age, 59.5 years (range, 47-68 years) who underwent chemoradiotherapy followed by surgical resection for locally advanced NSCLC from 2002 to 2011 were retrospectively analyzed. In all cases, chemotherapy consisted of platinum-based combination therapy. Postoperatively, bronchopleural fistula occurred in 1 patient and Horner syndrome was observed in 1 patient. No treatment -related deaths were observed. The median of progression-free survival was 34.2 months. In conclusion, chemoradiotherapy should be the standard of care for locally advanced NSCLC. Trimodality therapy is still experimental but seems to be promising for certain subgroups of patients with locally advanced NSCLC.