title: Two-staged treatment strategy in patients with severe carotid or cerebrovascular diseases undergoing coronary artery bypass grafting.
abstract: OBJECTIVE
  There is no clear consensus on how to treat patients undergoing coronary artery bypass grafting (CABG) who have severe concomitant carotidcerebral artery stenosis. The aim of this study was to evaluate our surgical results in patients with severe carotid and/or cerebrovascular disease undergoing CABG.
  
  
  METHODS
  Between October 2003 and April 2009, a total of 47 such patients were treated at our institution with the following strategies: (1) protective carotid artery stenting for severe carotid stenosis performed either before (n = 20) or after (n = 5) CABG or (2) a superficial temporal artery-middle cerebral artery anastomosis procedure followed by CABG if indicated (n = 4). Off-pump CABG was performed in 75% of the patients.
  
  
  RESULTS
  There were no major perioperative strokes or in-hospital deaths; however, three patients had transient ischemic attacks and two had minor strokes during the early post-CABG period. All of the patients with postoperative cerebrovascular events had had unilateral carotid artery occlusion. There were no late deaths during the follow-up period (up to 6 years, with a mean of 27 months). However, major adverse cardiocerebrovascular events (MACCE) occurred in seven patients (14.9%). The rates of freedom from MACCE at 1 and 3 years were 92% and 74%, respectively.
  
  
  CONCLUSIONS
  It appears that our two-staged approach is safe and may reduce the risk of postoperative cerebrovascular events.
authors.affiliation: Division of Cardiovascular Surgery, Tominaga Hospital, Osaka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Minakata
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yunoki
authors.forename: Masatake
authors.initials: M
authors.lastname: Katsu
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Chino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects
references.citation: Circulation. 2006 Mar 14;113(10):e409-49
references.pmid: 16534023
references.citation: J Vasc Surg. 1995 Jan;21(1):146-53
references.pmid: 7823353
references.citation: Ann Thorac Surg. 2007 Nov;84(5):1508-13; discussion 1513-4
references.pmid: 17954054
references.citation: J Am Coll Cardiol. 2004 Mar 3;43(5):752-6
references.pmid: 14998612
references.citation: Catheter Cardiovasc Interv. 2006 Jan;67(1):142-8
references.pmid: 16342270
references.citation: Stroke. 1991 Jun;22(6):711-20
references.pmid: 2057968
references.citation: Stroke. 2006 Feb;37(2):435-9
references.pmid: 16373639
references.citation: Eur J Vasc Endovasc Surg. 2009 Apr;37(4):379-87
references.pmid: 19201215
references.citation: JACC Cardiovasc Interv. 2009 May;2(5):393-401
references.pmid: 19463460
references.citation: Interact Cardiovasc Thorac Surg. 2009 Aug;9(2):278-81
references.pmid: 19416961
references.citation: J Vasc Surg. 1995 Feb;21(2):359-63; discussion 364
references.pmid: 7853607
references.citation: Stroke. 2008 Feb;39(2):361-5
references.pmid: 18174484
references.citation: Circulation. 2007 Oct 30;116(18):2036-42
references.pmid: 17938290
references.citation: Eur J Cardiothorac Surg. 2008 Nov;34(5):1005-8
references.pmid: 18783959
references.citation: N Engl J Med. 2004 Oct 7;351(15):1493-501
references.pmid: 15470212
references.citation: N Engl J Med. 2008 Apr 10;358(15):1572-9
references.pmid: 18403765
references.citation: Eur J Anaesthesiol. 2005 Mar;22(3):165-70
references.pmid: 15852987