| Autor: |
D F, Bandyk, M R, Back, B L, Johnson, M L, Shames |
| Rok vydání: |
2003 |
| Předmět: |
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| Zdroj: |
The Journal of cardiovascular surgery. 44(3) |
| ISSN: |
0021-9509 |
| Popis: |
Management of patients with advanced atherosclerosis involving the extra-cranial carotid and coronary arteries should be individualized based on symptoms and disease severity. A liberal policy to identify high-grade carotid stenosis using duplex ultrasound testing prior to coronary revascularization is recommended. Carotid intervention is efficacious for stroke reduction in patients with severe (70% diameter reduction), bilateral internal carotid artery disease, especially if testing indicates abnormal cerebral perfusion via the circle of Willis. The morbidity of a combined carotid-coronary revascularization procedure should be less than 5%, but higher stroke and death rates can be expected in urgent cases with recent hemispheric symptoms. Patients with symptomatic50% internal carotid artery stenosis should be considered for carotid endarterectomy at the time of coronary revascularization. Carotid angioplasty with cerebral protection is also an appropriate option in "high-risk" cardiac patients, especially in vascular centers with expertise and experience in performing this procedure. A policy of carotid endarterectomy prior to coronary bypass grafting is justified only in patients with stable coronary disease, good ejection fraction, and is best-performed using regional anesthesia. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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