Abstract
The aim of the study was verification of surgical treatment in patients with combined atherosclerotic
disease of brachiocephalic and coronary arteries depending on the risk of cerebral and
cardiac complications development.
Material and methods. Between 2003 and 2011 in Bakoulev SCCVS we operated 825 patients with
combined hemodynamically significant injury of brachiocephalic and coronary arteries. Complex
diagnostics of cardiac and cerebral state was used in order to determine the strategy of surgical
management; subsets which stratified the risk for development of complications were evolved.
Depending on the level of examined factors the patients were divided into two groups: group 1 -
single-stage coronary and brachiocephalic intervention (219 patients - 26.5%), patients
from group 2 underwent carotid endarterectomy at the first stage (291 patients - 35.3%), patients
from group 3 underwent coronary artery bypass grafting under cardiopulmonary bypass or on the
beating heart. The significant factor to choose the method was the fact that more than 50% variables
referred to the appropriate risk group.
Results. Stage correction is more safe and effective method of surgical treatment of patients with
combined lesion of brachiocephalic and coronary arteries. Having adequate indications and full
support, single-stage operations can be performed with good results.
Conclusions. Comprehensive assessment of cerebral perfusion reserve and also assessment of coronary
and myocardial reserve with the risk stratification allow us to choose the optimal surgical
method in patients with combined lesion of coronary and carotid system and decrease the probability
of intra- and postoperative complications.
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