An alternative surgical approach to subclavian and innominate stenosis: a case series

Diagnostic Investigations as a Basis for Optimising Surgical Management of Vertebrobasilar Insufficiency Syndrome

Vertebrobasilar insufficiency (VBI) is one of the most common forms of cerebrovascular pathology. The progression of the VBI, especially in the context of inadequate therapy, often leads to the formation of a persistent neurological deficits within the framework of dyscirculatory encephalopathy and the consequences of a stroke in the vertebrobasilar system. This study demonstrate the importance of objective methods of patient investigation to optimize the choice of the most effective methods of surgical treatment for VBI in cases of ineffective medical treatment. We have shown that the optimization of the diagnostic algorithm contributes to the correct individualized determination of types of surgical treatment for patients with VBI. It was found that, in addition to traditional diagnostic methods, the use of radiographic methods (ultrasound Doppler, multispiral computed tomography with contrast enhancement) is invaluable for choosing the tactics of surgical treatment. We propose a significant outcome indicator like the blood flow reactivity index to determine the postoperative improvement of blood flow in the vertebral arteries. In addition, the need to perform cerebral angiography and consultations with related specialists to exclude pathologies with a similar clinical picture is emphasized.

Aorto-left common carotid artery bypass with off-pump coronary artery bypass

BACKGROUND

Although carotid artery disease can occur in patients who have coronary artery disease (CAD), ostial stenosis of a left common carotid artery (CCA) along with CAD is a rarely reported condition.

CASE REPORT

We describe a rare case of severe stenosis of the left CCA ostium and CAD, which were successfully treated with an off-pump coronary artery bypass and aorto-left CCA bypass. This strategy minimizes the risk of perioperative strokes. Furthermore, an aorto-supra aortic trunk bypass provides a more physiological blood flow pattern than cerebral approaches. This approach would be a safe and effective treatment option.

Concomitant aorto-right subclavian artery bypass with off-pump coronary artery bypass grafting: a case report

Background

Atherosclerotic stenosis of the brachiocephalic artery sometimes occurs in patients with coronary artery disease, and can cause stroke during the perioperative period of coronary artery bypass grafting.

Case presentation

We describe the case of a 77-year old male with severe stenosis of the brachiocephalic artery and severe coronary artery disease. He successfully underwent aorto-right subclavian artery bypass that was performed concomitantly with off-pump coronary artery bypass.

Conclusion

Concomitant aorto-subclavian artery bypass with off-pump coronary artery bypass grafting is a therapeutic option that minimizes the risk of perioperative stroke in patients with brachiocephalic artery stenosis and coronary artery disease.