“一站式”颈动脉支架植入及冠状动脉搭桥杂交手术1例报告并文献复习

"One-stop" hybrid operation of carotid stenting and coronary artery bypass grafting:A case report and literature review

目的探讨冠心病合并颈动脉严重狭窄的同期杂交手术方法并文献复习,提高对冠心病合并颈动脉狭窄的诊疗水平。方法报告1例"一站式"颈动脉支架植入(CAS)及冠状动脉搭桥(CABG)杂交手术治疗冠心病合并颈动脉严重狭窄病例,检索中国知网和PubMed数据库,结合文献分析,总结冠心病合并颈动脉狭窄的诊疗经验。结果本例男,64岁,因"间断胸闷1月余"入院,经冠脉造影、颈动脉超声及脑血管造影等影像学检查提示冠心病(三支病变)合并双侧颈动脉严重狭窄,右侧脑半球缺血严重。局麻下先行右侧颈动脉CAS,再转为全麻行非体外循环辅助CABG,手术过程顺利,患者恢复情况良好。术后3个月随访,患者无胸闷及头颈部不适。通过数据库检索,共纳入14篇文献,报道了590例患者,男427例(72.4%),女163例(27.6%);均经CAS及CABG同期杂交手术治疗,先行CAS,再行CABG,两个手术间隔时间不超过24 h;术后发生脑卒中21例(3.5%),围术期心肌梗死11例(1.8%),住院死亡26例(4.4%);术后随访结果满意。结论 "一站式"CAS及CABG杂交手术对于冠心病合并颈动脉狭窄患者是一种较好的治疗选择,但需要在杂交手术室进行,且对术者技术要求较高。

Objective To improve the diagnosis and treatment of coronary heart disease with carotid stenosis, explore synchronous hybrid treatment for coronary heart disease with severe carotid stenosis and review of literature. Methods A case of "one-stop" carotid artery stenting(CAS) and coronary artery bypass grafting(CABG) hybrid surgical treatment of coronary heart disease with severe carotid stenosis was reported in present paper. Searching the China National Knowledge Infrastructure(CNKI) and PubMed databases, several literatures were retrieved and analyzed to summarize the experience of diagnosis and treatment of coronary heart disease with severe carotid stenosis. Results A 64-year-old male patient was admitted to our hospital due to intermittent chest tightness for more than one month. Imaging examination, including coronary angiography, carotid ultrasound and cerebral vessel angiography, showed that severe coronary heart disease with bilateral carotid stenosis and obvious cerebral ischemia in the right brain hemisphere. Operation for right carotid artery was first performed under local anesthesia, and then the off-pump CABG was carried on under general anesthesia. Operation procedure was going well, and the recovery was good. The patient was followed up 3 months after operation, and there was no chest tightness and head-neck discomfort. Fourteen articles were obtained through database retrieval, and a total of 590 patients were reported including 427 male cases(72.4%) and 163 female cases(27.6%). All of them were treated at same stage with first CAS and sequential CABG. The interval between CAS and CABG was less than 24 hours. Findings indicated that postoperative stroke in 21 cases(3.5%), perioperative myocardial infarction in 11 cases(1.8%) and in-hospital death in 26 cases(4.4%). The follow-up results were satisfactory. Conclusion "One-stop" CAS and CABG hybrid treatment is one of good therapeutic options for patients with coronary heart disease and carotid stenosis, but this operation needs to be carried out in the hybrid operation room, and the technical requirements for the surgeons are relatively high.