Koroner arter baypas cerrahisine giden hastalarda asemptomatik ciddi karotis arter darlığı tedavi yönetimi: Klinik analiz

Abstract

Amaç: Koroner arter hastalığı nedeni ile ameliyat yapılacak olan hastalarda semptomatik karotis arter darlığının tedavisi hakkında kılavuzlarda görüş birliği sağlanmış, asemptomatik hastalarda ise kesin görüş birliği sağlanamamıştır. Bu hastalara yaklaşım şeklimizi ve sonuçlarımızı paylaşmak istedik. Gereç ve Yöntemler: Ocak 2016-Ocak 2021 tarihleri arasında koroner arter baypas cerrahisi uyguladığımız tek taraflı %70’ten yüksek karotis arter darlığı bulunan asemptomatik 40 hasta (Grup 1) ile koroner arter baypas cerrahisi uygulanan fakat karotis arter darlığı olmayan 40 hasta (Grup 2) serebrovasküler komplikasyonlar ve cerrahinin sonuçları yönünden karşılaştırıldı. Tüm hastalara koroner arter baypas cerrahisi uygulandı ve karotis arter darlığına müdahale edilmedi. Bulgular: Preoperatif hipertansiyon görülme oranı Grup 1’de daha fazlaydı (%65 ve %32,5, p=0,007). Grup 1 hastalarda koroner arter baypas ameliyatı baypas greft sayısı Grup 2 hastalara göre daha fazla idi (3,250,58 ve 2,870,68, p=0,010). Hiçbir hastada majör serebrovasküler olaya rastlanmadı ve mortalite gelişmedi. Sonuç: Asemptomatik tek taraflı karotis darlığının eşlik ettiği koroner arter hastalarında koroner arter cerrahisinin güvenli olduğu sonucuna vardık. Bu konu ile ilgili kesin görüş birliğine ulaşabilmek için çok merkezli prospektif araştırmaların yapılmasının faydalı olacaktır.

Keywords

• koroner arter hastalığı
• karotis darlığı
• koroner arter baypas

Management of asymptomatic severe carotid artery stenosis in patients undergoing coronary artery bypass surgery: Clinical analysis

Abstract

Aim: A consensus was reached in the guidelines on the treatment of symptomatic carotid artery stenosis in patients who will undergo surgery for coronary artery disease, but no definite consensus was reached in asymptomatic patients. We wanted to share our approach to these patients and our results. Material and Methods: Between January 2016 and January 2021, 40 asymptomatic patients with unilateral carotid artery stenosis greater than 70% (Group 1) who underwent coronary artery bypass surgery and 40 patients who underwent coronary artery bypass surgery but did not have carotid artery stenosis (Group 2) were compared in terms of cerebrovascular complications and surgical outcomes. All patients underwent coronary artery bypass surgery and carotid artery stenosis was not intervened. Results: The incidence of preoperative hypertension was higher in Group 1 patients (65% vs 32.5%, p=0.007). The number of coronary artery bypass surgery bypass grafts was higher in Group 1 patients compared to Group 2 patients (3.250.58 vs 2.870.68, p=0.010). No major cerebrovascular accident was encountered in any patient and no mortality occurred. Conclusion: We concluded that coronary artery surgery is safe in patients with coronary artery disease with asymptomatic unilateral carotid stenosis. In order to reach a definitive consensus on this issue, it would be beneficial to conduct multicenter prospective studies.

Keywords

• Coronary artery disease
• carotid stenosis
• coronary artery bypass

References

1. 1. Cohen GI, Aboufakher R, Bess R et al. Relationship between carotid disease on ultrasound and coronary disease on CT angiography. JACC Cardiovasc Imaging 2013; 6: 1160-7.
2. 2. Novo S, Corrado E, Novo G, Dell’Oglio S. Association of carotid atherosclerosis with coronary artery disease: comparison between carotid ultrasonography and coronary angiography in patients with chest pain. G Ital Cardiol (Rome) 2012; 13: 118-23.
3. 3. Madisetty MK, Kumaraswami K, Katham S et al. Assessment of oxidative stress markers and carotid artery intima-media thickness in elderly patients without and with coronary artery diesase. Indian J Clin Biochem 2016; 31: 278-85.
4. 4. Fukuda I, Osaka M, Nakata H, Sakamoto H. Clinical outcome for coronary artery bypass grafting in patients with severe carotid occlusive disease. J Cardiol 2001; 38: 303-9.
5. 5. Uekita K, Funayama N, Nishiura T et al. Prevelance of cervical and cerebral atherosclerosis and silent brain infarction in patients with multivessel coronary artery diesase. J Cardiol 2001; 38: 13-20.
6. 6. Naylor AR, Mehta Z, Rothwell PM, Bell PR. Carotid artery disease and stroke during coronary artery bypass: critical review of the literature. Eur J Vasc Endovasc Surg 2002; 23: 283-94.
7. 7. Mao Z, Zhong X, Yin J, Zhao Z, Hu X, Hackett ML. Predictors associated with stroke after coronary artery bypass grafting: a systematic review. J Neurol Sci 2015; 357: 1-7.
8. 8. Neumann FJ, Sousa-Uva M, Ahlsson A et al. 2018 esc/eacts guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87-165.

9. 9. Illuminati G, Ricco JB, Calio F et al. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting. J Vasc Surg 2011; 54: 993-9.
10. 10. Lescan M, Andic A, Bartos O, Schlensak C, MustafiM. Carotid endarterectomy versus conservative management of the asymptomatic carotid stenosis before coronary artery bypass grafting: a retrospective study. BMC Cardiovasc Disorders 2020; 20: 303.
11. 11. Tankut A. Karotis Arter Darlıkları. Periferik arter ve ven hastalıkları ulusal tedavi kılavuzu. Editör: A Kürşat Bozkurt. Bayçınar Tıbbi Yayıncılık ve Reklam Hiz Tic Ltd Şti. 2021: sayfa 100-33.
12. 12. Borger MA, Fremes SE, Weisel RD et al. Coronary bypass and carotid endarterectomy: does a combined approach increase risk? A metaanalysis. Ann Thorac Surg 1999; 68: 14-20.
13. 13. Versaci F, Reimers B, Del Giudice C et al. Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass grafting: the SHARP study. JACC Cardiovasc Interv 2009; 2: 393-401.
14. 14. Walker MD, Marler JR, Goldstein M et al. Endarterectomy for asmptomatic carotid artery stenosis. JAMA 1995; 273: 1421-28.