[HSF] a carotid and coronary case

[hgrmd at aol.com]

Tohru, 
? If the patient had asymptomatic 80-90% carotid stenosis, then I would just do the CABG first.? However, if it was "99%", I would do combined.? I realize that the majority of periop CABG CVA's are embolic, but I would worry about a small particle producing 100% obstruction, or perhaps a low flow state could produce the same result.? Certainly if the patient had active neurologic symptoms, then I would do a combined procedure for less severe disease.? As you can see, it's a complicated problem without discrete, neat little answers.? That's what makes medicine and surgery an art to a certain extent.

Hal


-----Original Message-----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 8 Aug 2007 9:04 am
Subject: Re: AW: [HSF] a carotid and coronary case



Hal
> My current 
> indications for a combined procedure are critical carotid disease  with
> critical symptomatic CAD.
Does it mean that you indicate for a combined CABG/CEA even for asymptomatic
stable critical carotid disease? Rationale? Educate me.

When I was in US training, I have rarely seen a combined procedure. (The
center where cardiac and vascular teams were independently separated!) My
understanding was that only indication for a combined procedure was unstable
symptomatic cerebral ischemia together with heart problem. That is why I
describe anaortic OPCAB for Roberto's question.
-- 
Tohru Asai


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