January 1-December 1, 2014
Background --- Carotid endarterectomy (CEA) and coronary artery bypass (CABG) surgery as a single stage procedure has an increased risk for stroke and perioperative myocardial infarction. This is a case report on the anesthetic challenges and management of a patient undergoing combined CEA and CABG.
Case --- This is a case of a 63-year old man who came In for chest pain. Coronary angiography revealed a severe triple vessel disease with critical left main involvement. He was also diagnosed with a totally occluded left distal internal carotid artery and 70-99% right internal carotid artery stenosis with type V plaque morphology and a history of cerebral vascular accident (CVA) 2 years prior to this presentation. He underwent a combined CEA and CABG procedure under IABP and CPB pump support. He did not have any major adverse event and was discharged improved.
Conclusion --- The use of preoperative IABP, neurologic monitors and employing neuroprotective measures in combined CEAlCABG on patients withseverely compromised coronary and carotid arteries may improve the outcome.