Цитата:
Сообщение от thorn
Кстати, уважаемые коллеги, как вы относитесь к каротидному стентированию перед коронарным шунтированием при значимом поражении каротид - симптоматическом или асимптоматических стенозах более 80%?
|
Medical/Scientific Statements: Special Report: Guidelines for Carotid Endarterectomy: A Multidisciplinary Consensus Statement From the Ad Hoc Committee, American Heart Association.
American Heart Association Departments
Circulation. 91(2):566-579, January 15, 1995.
Patients with either symptomatic or asymptomatic CAD in the presence of symptomatic coronary artery disease represent a difficult decision matrix. The options include operating on the carotid lesion first, with an increased risk of morbidity and mortality from myocardial infarction; operating on the coronary lesion first, with an increased risk of perioperative stroke; operating on both lesions during the same period of anesthesia; or operating on the coronary arteries alone. Of the 57 English-language papers on this topic, only 19 report on more than 50 patients. A meta-analysis of 56 reports reviewed three operative strategies: simultaneous carotid and coronary artery bypass grafting (CABG), carotid surgery followed by CABG, and CABG followed by carotid surgery. The meta-analysis indicates that the perioperative stroke rate was similar if carotid and coronary surgery were combined or if carotid surgery preceded coronary bypass grafting. The frequency of stroke was significantly greater if CABG preceded carotid surgery. However, the frequency of myocardial infarction (P=.01) and death (P=.02) were greater when carotid surgery preceded coronary bypass grafting Table 1 [58-121].
The optimal strategy for management of patients with combined coronary and carotid disease will be established only by a well-designed prospective randomized trial.
[
Ссылки доступны только зарегистрированным пользователям ]