[HSF] a carotid and coronary case

[Prasanna Simha]

Goes to show how much of the brain we really use !! ;-)
Prasanna
Michael Firstenberg wrote:
> 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
>>
>>
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>> OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE 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
>> disclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>>
>>
>> ________________________________________________________________________
>> AOL now offers free email to everyone.  Find out more about what's free
>> from AOL at AOL.com.
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>> OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE 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
>> disclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>>
>>     
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE 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 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
>