[HSF] a carotid and coronary case

[psimha]

Who is Al bundy ? I know only of a Ted Bundy  ;-)
Prasanna
Michael Firstenberg wrote:
> My hero Al Bundy says the brain just needs to be kept wet.
>
>
>
> Michael Firstenberg <msfirst at gmail.com>
>
> -----Original Message-----
> From: "Prasanna Simha" <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: 8/8/2007 10:02 PM
> Subject: Re: [HSF] a carotid and coronary case
>
> 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
>>>
>>>
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