[HSF] a carotid and coronary case

[Ajit Damle]

Al Bundy is my hero too!

 

Ajit Damle

 

 

 

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of psimha
Sent: Thursday, August 09, 2007 6:06 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] a carotid and coronary case

 

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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