Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease?
Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease?
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对于有症状或无症状颈动脉疾病的患者，CABG 后中风的风险是否值得分期或同步重建？
DOI：
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复制
发表时间：
2009
影响因子：
1.4
通讯作者：
A. Naylor
中科院分区：
文献类型：
--
作者：
A. Naylor
冠状动脉旁路移植术（CABG）患者并发颈动脉疾病的处理仍然存在争议。治疗方案包括行孤立性冠状动脉搭桥、同步颈动脉内膜切除术（CEA）加冠状动脉搭桥、分期CEA-CABG、逆分期CABG-CEA、同步CEA+CABG旁路搭桥（OFFCAB）和分期颈动脉成形术合并支架置入（CAS）后再行冠状动脉搭桥。要使任何这些联合或分阶段干预措施在临床上有效，必须满足以下条件：(1)冠状动脉搭桥必须是经证实的缺血性心脏病的干预措施；(2)卒中必须是围手术期发病率和死亡率的重要原因；(3)冠状动脉搭桥后卒中的发生率必须高到足以证明预防方案的合理性；(4)颈动脉疾病必须是冠状动脉搭桥后卒中的重要原因；(5)CEA （CAS）必须是经证实的颈动脉疾病干预措施；(6)预防性CEA （CAS）应降低冠状动脉搭桥后卒中的风险。本文回顾了文献，得出结论，条件1、2和5是满足的，条件3是可以实现的，只要有针对性的高风险亚群。然而，有限的证据支持颈动脉疾病是冠状动脉搭桥后卒中的主要原因这一论点，并且系统评价中观察到的相对较高的程序性风险可能会抵消预防性干预（无论是CAS还是CEA）所带来的任何潜在益处。有卒中或TIA病史的CABG患者预防性颈动脉介入治疗是合理的。关于CEA （CAS）在无症状双侧颈动脉疾病患者中的作用的争论仍在继续，但似乎很少有证据证明CABG患者单侧无症状颈动脉疾病预防性CEA或CAS的合理性。
The management of patients undergoing coronary artery bypass grafting (CABG) who are found to have co-existent carotid artery disease remains controversial. Management options include performing an isolated CABG, synchronous carotid endarterectomy (CEA) plus CABG, staged CEA-CABG, reverse staged CABG-CEA, synchronous CEA+CABG off bypass (OFFCAB) and staged carotid angioplasty with stenting (CAS) followed by CABG. For any of these combined or staged interventions to be clinically effective, the following conditions must be met; (1) CABG must be a proven intervention for ischaemic heart disease, (2) stroke must be an important cause of peri-operative morbidity and mortality, (3) the incidence of post-CABG stroke must be high enough to justify a programme of prevention, (4) carotid disease must be an important cause of post-CABG stroke, (5) CEA (CAS) must be a proven intervention in carotid artery disease and (6) prophylactic CEA (CAS) should reduce the risk of post-CABG stroke. This paper reviews the literature and concludes that conditions 1, 2 and 5 are met and that condition 3 can be achieved provided high risk' subgroups are targeted. However, there is limited evidence to support the contention that carotid disease is a major cause of post-CABG stroke and any potential benefit conferred by prophylactic intervention (whether by CAS or CEA) may be offset by the relatively high procedural risks observed in systematic reviews. Prophylactic carotid intervention is justified in CABG patients with a prior history of stroke or TIA. Debate continues about the role of CEA (CAS) in patients with asymptomatic bilateral carotid disease, but there seems to be little evidence to justify prophylactic CEA or CAS in CABG patients with unilateral asymptomatic carotid disease.
接受冠状动脉搭桥手术的患者的颈动脉疾病。
DOI：
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发表时间：
1981
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Breslau,PJ;Fell,G;Ivey,TD;Bailey,WW;Miller,DW;StrandnessJr,DE
通讯作者：
StrandnessJr,DE
心脏手术期间严重动脉粥样硬化升主动脉的处理。
DOI：
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发表时间：
1992
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Wareing,TH;Davila-Roman,VG;Barzilai,B;Murphy,SF;Kouchoukos,NT
通讯作者：
Kouchoukos,NT