[HSF] a carotid and coronary case

Sat Aug 4 08:09:10 EDT 2007

I certainly think that you could consider just doing the  CABG  alone, but I would be  very worried the whole time I was doing the case and in the post op period when pts get somewhat hypercoagulable. I doubt there is any data that you can find for a pt with this exact situation. I am not sure there is a "right" answer.

Tom Martin
U of Florida
Gainesville

-----Original Message-----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Sat, 4 Aug 2007 1:06 am
Subject: RE: AW: [HSF] a carotid and coronary case

To Tea, Hal, Tom, Ed and other cardiovascular surgeons amongst us,

 think it was Ben who asked the question how remote the stroke was - I am sure 
oberto will answer, but assuming the stroke was remote (years) and patient has 
ot had any recent neurological event would any do the CABG alone and ignore the 
arotid? Assume also that he had been known to have carotid disease for some 
ears and that a conscious decision had been made that carotid surgery was not 
ndicated on its own merit. 

ssuming again the stroke was remote and he did not have cardiac disease would 
his count as a symptomatic indication for carotid surgery?

ould any OPCAB surgeons do a case like this anaortic and ignore the 
erebrovascular disease?

ni

 Date: Fri, 3 Aug 2007 21:24:33 -0700> From: tacuff at swbell.net> Subject: Re: 
W: [HSF] a carotid and coronary case> To: OpenHeart-L at lists.hsforum.com> CC: > 
 I stopped using a shunt after my first few cases in private practice because I 
o not believe that flow occlusion is the most commom cause of stroke if one can 
ountinely accomplish the closure in around twenty minutes or so (often less). 
or the first decade approximately I did not patch, but gradually began patching 
verything as I thought it compensated for distal plague that did not taper well 
nd my technique speeded up. In a case like this a shunt might be reasonable if 
asy to place, and I would have have no fear in sewing up without a patch to 
ecrease ischemia (with or without a shunt) to hopefully around ten to fifteen 
inutes...which still may be a lifetime. This is clearly high risk by any 
pproach. I have done a (small) number of totally occluded contralateral 
arotids without shunt and with patch and likely will continue to.> tea> > > 
---- Original Message ----> From: prasannasimha <prasannasimha at gmail.com>> To: 
penHeart-L at lists.hsforum.com> Sent: Friday, August 3, 2007 9:12:02 PM> Subject: 
e: AW: [HSF] a carotid and coronary case> > > Then a 4 vessel MR angio would be 
n order.. (The cases I was referring > to actually had 3 of 4 vessels occluded) 
ith antegrade cerebral > malperfusion induced by even by posture change.> 
ncidentally what are your indications for patching ?> What size shunts do you 
se and what is the size of the carotid when you > would not place a shunt ?> 
rasanna> Edward Bender wrote:> > The reasons that a shunt could not be placed 
re usually due to the > > small size of the distal internal carotid or, less 
ommonly, severe > > tortuosity. In the presence of only one patent internal 
arotid > > artery feeding the contralateral side, the arterial size is usually 
 > quite large. I have not had a problem with hemispheric ischemia with > > 4 
r 5 minutes of no flow in the heparinized patient. I would also > > hazard a 
uess, and have anecdotes, that you could safely do the case > > without a 
hunt. In rare cases the vertebral system will not feed the > > anterior 
irculation and this would be a problem. Where I have run > > into problems with 
ost-op cerebral ischemia is due to either > > embolization of material or air, 
r a distal shunt injury to the > > carotid intima raising a flap.. I think that 
he committee that > > designed the brain's vascular anatomy got it right.> >> > 
d Bender, MD> >> >> > On Aug 3, 2007, at 8:45 PM, prasannasimha wrote:> >> >> 
hat would your strategy be in the no flow period ? (between > >> arteriotomy 
nd shunt introduction) and if the shunt for some reason > >> cannot be placed 
> >> Prasanna> >>> >> Jbflegejr at aol.com wrote:> >>> I would do a left carotid 
ndartectomy and a couple of days later do > >>> the CABG. John Flege> >>>> >>>> 
>>> >>> ************************************** Get a sneak peek of the > >>> 
ll-new AOL at http://discover.aol.com/memed/aolcom30tour> >>> 
______________________________________________> >>> OpenHeart-L mailing list> 
>>> >>> Send postings to:> >>> OpenHeart-L at lists.hsforum.com> >>>> >>> To 
NSUBSCRIBE, to CHANGE email address, or to view archives:> >>> 
ttp://mmp.cjp.com/mailman/listinfo/openheart-l> >>>> >>> All messages 
ransmitted by the OpenHeart-L are subject to the > >>> policies and disclaimers 
osted at:> >>> http://www.hsforum.com/listdisclaim> >>> -----------------------------------------> 
>>> >>>> >> _______________________________________________> >> OpenHeart-L 
ailing list> >>> >> Send postings to:> >> OpenHeart-L at lists.hsforum.com> >>> >> 
o UNSUBSCRIBE, to CHANGE email address, or to view archives:> >> 
ttp://mmp.cjp.com/mailman/listinfo/openheart-l> >>> >> All messages transmitted 
y the OpenHeart-L are subject to the > >> policies and disclaimers posted at:> 
> http://www.hsforum.com/listdisclaim> >> -----------------------------------------> 
> > _______________________________________________> > OpenHeart-L mailing 
ist> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To 
NSUBSCRIBE, to CHANGE email address, or to view archives:> > 
ttp://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted 
y the OpenHeart-L are subject to the > > policies anddisclaimers posted at:> > 
ttp://www.hsforum.com/listdisclaim> > -----------------------------------------> 
> >> > _______________________________________________> OpenHeart-L mailing 
ist> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to 
HANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> 
 All messages transmitted by the OpenHeart-L are subject to the policies and > 
isclaimers posted at:> http://www.hsforum.com/listdisclaim> 
----------------------------------------> _______________________________________________> 
penHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > 
o UNSUBSCRIBE, to CHANGE email address, or to view archives:> 
ttp://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by 
he OpenHeart-L are subject to the policies and > disclaimers posted at:> 
ttp://www.hsforum.com/listdisclaim> -----------------------------------------
________________________________________________________________
eleb spotting – Play CelebMashup and win cool prizes
ttps://www.celebmashup.com/index2.html_______________________________________________
penHeart-L mailing list
Send postings to:
OpenHeart-L at lists.hsforum.com
To UNSUBSCRIBE, to CHANGE email address, or to view archives:
ttp://mmp.cjp.com/mailman/listinfo/openheart-l
All messages transmitted by the OpenHeart-L are subject to the policies and 
isclaimers posted at:
ttp://www.hsforum.com/listdisclaim
----------------------------------------

________________________________________________________________________
AOL now offers free email to everyone.  Find out more about what's free from AOL at AOL.com.