AW: [HSF] a carotid and coronary case

[Tea Acuff]

I would agree. 
If I were to do a combined case and cool to 18 degrees (per Prasanna), I would be tempted to use that as neuroprotection also. I would be somewhat worried about edema immediately after warming.
On the subject of carotids I unfortunately recently had the chance to confirm the validity of my "clonus test" for injury vs infarct (neuro) post carotid. The patient had no clonus, but was slow to awake and when he did he had complete right hemiparesis and aphasia, and I think nondominate inawareness. I got a doppler in the recover which showed good flow thru the LICA. Over the next hour he improved in roughly an ascending homunculus pattern. First the leg, then shoulder, then arm, then roughly hand and face with verbal recognition and lastly fluency.
Because I rarely but occasionally see this I am reluctant to assault the brain twice in one setting without observing normal function between insults if at all possible.
 
tea


----- Original Message ----
From: "Douville, Chuck" <ecdouville at orclinic.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, August 3, 2007 11:07:54 AM
Subject: RE: AW: [HSF] a carotid and coronary case


If the pt has medically stable coronary disease, fix  the carotid  first and stage the cabg afe days to weeks later.

-----Original Message-----
From: "Dr. Roberto Battellini" <battr at medizin.uni-leipzig.de>
To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
Sent: 8/3/07 8:25 AM
Subject: AW: [HSF] a carotid and coronary case



How would the members operate a case with:

Man 52 years old, had a stroke with hemiparesis after the right carotid was
occluded. Left carotid 95% stenosed. He needs 3 arterial grafts for 3 vessel
disease. The right hemisphere is perfused from the left carotid.

Roberto

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