CAROTID ENDARTERECTOMY IN CONCOMITANT LESIONS OF THE CAROTID AND CORONARY ARTERIES

N.U. Usmanov, A.K. Baratov, D.D. Sultanov, M.O. Kurbanova
Chair of Hospital Surgery, Tadjik State Medical University,
Dushanbe, Republic of Tadjikistan

The results of examination and treatment of 63 patients aged 46 to 74 years have been analyzed. There were 60 men and 3 women. Doppler studies and angiography identified unilateral lesion of the carotid arteries (42 patients) and bilateral lesion (21 patients). Occlusion of the contralateral internal carotid artery was recognised in 5 and stenosis in 16 patients. Multiple lesions of the branches of the aortic arch were diagnosed in 22 patients. Concomitant lesions of other arteries were identified: abdominal aorta and lower extremity arteries in 56, of the renal arteries in 5, and of the visceral branches of the abdominal aorta in 3 patients. Stage I insufficiency (symptom-free) was recorded in 10 patients, stage II (transient ischemic attacks) in 25, stage III (chronic vasculocerebral insufficiency) in 21 and stage IV (residual phenomena of ischemic stroke) in 7 patients. The coronary disease was revealed in all patients. 14 patients were in functional class I angina pectoris, 32 in class II, 13 in class III, and 4 in class IV. Besides, 16 patients had a history ofmyocardial infarction. Of these, 5 patients suffered it twice. Different forms of cardiosclerosis were recorded in 39 patients. Clinical examination permitted identification of the following risk factors in patients undergoing carotid endarterectomy: CAD (63 patients), arterial hypertension (50 patients), diabetes mellitus (19), overweight (3), age exceeding 70years (6), tobacco-smoking (62), stroke in the anamnesis (7), freguent transient ischemic attacks (12), lesion of the contralateral internal carotid artery (stenosis, occlusion) (21 patients). Operation was indicated in hemodynamically significant stenosis (over 60%) of carotid artery bifurcation with the signs of brain ischemia and symptom-free stenosis as the first stage before reconstructive operations on other arteries. In the preoperative period, the patients were without fail administered antianginal drugs. Monotherapy with nitrates or P-blockers or calcium antagonists was mainly provided to patients in functional class 1-11 angina pectoris, whereas combined therapy (2 drugs) to patients in functional class II-III angina pectoris. Finally, the group of the patients with severe angina pectoris of effort and rest received, in addition to the mandatory combination of the three drugs, cardiac glycosides and diuretics according to indications (in the event of heart failure). Lessfreguent occurrence or complete disappearance of angina pectoris attacks, palpitation, dyspnea, peripheral edemas, on the one hand, and the increase of ejection fraction and myocardial contractility as well as the positive dynamics of the ECG, on the other hand, were regarded as criteria for the patients 'preparedness for operation. All the patients were operated on under local anesthesia, which considerably lowered the risk of cardial complications common to anesthesia. Before carotid artery cross-clamping all the operated were subjected to the occlusion test of the artery, lasting 3 minutes.The patients' consciousness being monitored, high brain tolerance to ischemia was identified. Only 3 patients undergoing operation reguired the use of the internal shunt for brain protection. In the early postoperative period, one patient developed ischemic stroke in the area of the repaired internal carotid artery because of its thrombosis. One (1.6%) patient had transient disturbance of coronary circulation on the 2nd day following operation. This complication occurred in the patient in functional class IV angina pectoris, coexistent arterial hypertension and atherosclerosis obliterans of lower extremity vessels. Coronary insufficiency developed in this patient due to postoperative hypertension. No cases of myocardial infarction or lethal outcomes were recorded.

P. 68

« Back