Key result
Simultaneous CABG and CEA preserves regional cerebral blood flow, increasing flow ~13% in specific zones.
Why the study?
The study aimed to evaluate the effect of simultaneous coronary artery bypass grafting and carotid endarterectomy on regional cerebral blood flow using single photon emission computed tomography.
Does simultaneous coronary artery bypass grafting and carotid endarterectomy affect regional cerebral blood flow in patients with combined atherosclerotic lesions of the carotid and coronary arteries?
Observational (n=14)
Does simultaneous coronary artery bypass grafting and carotid endarterectomy affect regional cerebral blood flow in patients with combined atherosclerotic lesions of the carotid and coronary arteries?
Absolute Event Rate: 61.43% vs 54.14%
p-value: p=0.037634
Simultaneous CABG and carotid endarterectomy does not have a statistically significant negative effect on regional cerebral blood flow in the early postoperative period, with isolated areas showing benign postischemic hyperperfusion.
Should not yet change surgical practice for combined lesions; hypothesis-generating for cerebral perfusion and requires randomized confirmation.
Aim. To evaluate the effect of simultaneous surgical intervention on regional cerebral blood flow (CBF) based on single photon emission computed tomography (SPECT). Material and Methods. The study included 14 patients with hemodynamically significant stenoses of the coronary and carotid arteries that underwent coronary artery bypass grafting concomitant with carotid endarterectomy. Brain SPECT with 99mTcHMPAO was performed twice: before surgery and in the postoperative period at days 5–7. Results. Overall, the group showed a statistically significant increase in regional cerebral blood flow in comparison with preoperative indicators in the area of the right caudate nucleus from 54.14±6.84 mL/100 g/min in the preoperative stage to 61.43±13.35 mL/100 g/min after surgery, p=0.037634, and in the left temporal lobe from 41.64±2.73 mL/100 g/min in the preoperative stage to 44.57±4.91 mL/100 g/min after surgery, p=0.019224. There were deviations of CBF less than 5 mL/100 g/min in 11 cases (79%) in most of the analyzed regions; the changes in cerebral blood flow were more pronounced in 3 cases: there was a diffuse increase in cerebral blood flow in 2 cases (14%) and а diffuse reduction of cerebral blood flow in 1 case (7%). Conclusion. Data obtained in a small sample of patients with combined atherosclerotic lesions of the carotid and coronary arteries preliminary suggest the absence of a statistically significant negative effect of simultaneous surgical intervention on the regional cerebral blood flow in all major basins of the cerebral arteries of the brain. Observed increase in the perfusion indices in the isolated analyzed zones, not exceeding 34%, may correspond to reactive benign postischemic hyperperfusion within the concept of reperfusion syndrome.
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Korotkevich et al. (2019) conducted an observational in Combined atherosclerotic lesions of the carotid and coronary arteries (n=14). Simultaneous coronary artery bypass grafting and carotid endarterectomy vs. Preoperative baseline was evaluated on Regional cerebral blood flow in the right caudate nucleus (mL/100 g/min) (p=0.037634). Simultaneous coronary artery bypass grafting and carotid endarterectomy did not negatively affect regional cerebral blood flow, with significant increases observed in specific isolated zones.
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