AW: [HSF] a carotid and coronary case

[Tea Acuff]

I wonder why carotid stenting is becoming popular since (I guess all us having strokes) none of us can remember having a patient stroke after CEA???
tea


----- Original Message ----
From: Mitch Lirtzman <drmitch at cox.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, August 4, 2007 5:43:28 PM
Subject: Re: AW: [HSF] a carotid and coronary case


Like Ed, our group is the C, V, and T surgeons. I patch 'em all and shunt 
selectively. No stump pressures. Using clinical observation, I open the ICA 
clamp and watch the back-bleeding. If it's brisk, red and pulsatile, I 
clamp and operate. No strokes in years.
MitchAt 09:12 PM 8/3/2007, you wrote:
>Then a 4 vessel MR angio would be in order.. (The cases I was referring to 
>actually had 3 of 4 vessels occluded) with antegrade cerebral malperfusion 
>induced by even by posture change.
>Incidentally what are your indications for patching ?
>What size shunts do you use and what is the size of the carotid when you 
>would not place a shunt ?
>Prasanna
>Edward Bender wrote:
>>The reasons that a shunt could not be placed are usually due to the small 
>>size of the distal internal carotid or, less commonly, severe 
>>tortuosity.   In the presence of only one patent internal carotid artery 
>>feeding the contralateral side, the arterial size is usually quite 
>>large.  I have not had a problem with hemispheric ischemia with 4 or 5 
>>minutes of no flow in the heparinized patient.  I would also hazard a 
>>guess, and have anecdotes,  that you could safely do the case without a 
>>shunt.  In rare cases the vertebral system will not feed the anterior 
>>circulation and this would be a problem.  Where I have run into problems 
>>with post-op cerebral ischemia is due to either embolization of material 
>>or air, or a distal shunt injury to the carotid intima raising a flap.. I 
>>think that the committee that designed the brain's vascular anatomy got 
>>it right.
>>
>>Ed Bender, MD
>>
>>
>>On Aug 3, 2007, at 8:45 PM, prasannasimha wrote:
>>
>>>What  would your strategy be in the no flow period ? (between 
>>>arteriotomy and shunt introduction) and if the shunt for some reason 
>>>cannot be placed ?
>>>Prasanna
>>>
>>>Jbflegejr at aol.com wrote:
>>>>I would do a left carotid endartectomy and a couple of days later do 
>>>>the CABG. John Flege
>>>>
>>>>
>>>>
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