Staged coronary artery bypass grafting after percutaneous angioplasty for intracranial vascular stenosis.
OBJECTIVE
Cerebrovascular disease is commonly associated with coronary artery disease and is a major risk factor for cardiac surgery. Concomitant coronary artery bypass grafting and carotid endarterectomy may reduce the risk of stroke; however, this staged operation is effective only for extracranial lesions. The strategy for on-pump coronary artery bypass grafting for patients with intracranial vascular stenosis is still controversial.


METHODS
The subjects were 157 consecutive candidates for coronary artery bypass grafting who underwent computed tomography and digital subtraction cerebral angiography preoperatively to check for cerebrovascular disease. Additional single-photon emission computed tomography was performed to evaluate cerebral ischemia, according to the neurologist's request. Patients with diffuse intracranial vascular stenosis impossible to treat with percutaneous transluminal angioplasty underwent off-pump coronary artery bypass grafting. Patients with a circumflex coronary artery lesion first underwent percutaneous transluminal angioplasty for cerebral vascular stenosis followed by secondary on-pump coronary artery bypass grafting.


RESULTS
Three patients were selected for staged operations. Percutaneous transluminal angioplasty was performed for 4 intracranial stenotic lesions. All lesions were dilated successfully, and no complications developed during or after the procedure. All patients tolerated staged coronary artery bypass grafting and were extubated within 1 day without any mental disturbance. No further neurologic complication occurred, and computed tomography performed postoperatively revealed no significant changes.


CONCLUSIONS
Staged on-pump coronary bypass after percutaneous transluminal angioplasty for cerebrovascular disease may reduce the risk of stroke during cardiopulmonary bypass, and it is useful especially in patients with intracranial cerebrovascular disease.
Kihara
S
S
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Hiroshima, Japan. kiharas@msx.upmc.edu
Shimakura
T
T
Tanaka
S A
SA
Hanayama
N
N
Saito
N
N
Hirasawa
Y
Y
Sugawara
Y
Y
Maeba
S
S
Yoshizumi
H
H
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000379:methods; D002545:Brain Ischemia / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D003251:Constriction, Pathologic; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome