[HSF] a carotid and coronary case

[Michael Firstenberg]

Am I missing something on this case?

100% occlusion of 3/4 cerebral vessels and >90% to the 4th?

How is he getting oxygen to his brain?


-michael


On 8/8/07, hgrmd at aol.com <hgrmd at aol.com> wrote:
>
> 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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