ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Successful coronary artery bypass grafting in a patient with bilateral internal carotid artery occlusion: a case report
Ferit Çiçekçioğlu, Ali İhsan Parlar, Levent Altınay, Kerem Yay, Ayşen Aksöyek, Salih Fehmi Katırcıoğlu
Department of Cardiovascular Surgery, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara
The best management regimen for patients with coronary artery disease requiring surgery and bilateral total internal carotid artery occlusion remains controversial. A 61-year-old male patient presented with unstable angina pectoris. His medical history revealed that he had a cerebrovascular accident 11 years ago. On physical examination, he had dysarthria and monoparesis on the right upper extremity. Coronary and carotid angiography revealed critical coronary artery stenosis and total occlusion of bilateral internal carotid arteries, total occlusion of the right vertebral artery and 40% stenosis of the left proximal vertebral artery. After general intravenous fentanyl anesthesia, low dose heparin was administered, and coronary artery bypass grafting (CABG) was performed under off-pump beating heart condition. Systolic blood pressure was maintained above 120 mmHg to preserve cerebral blood flow during the operation. The postoperative course was uneventful and the patient was discharged in the 7th day postoperatively. If CABG is mandatory in patients having high cerebrovascular risk, off-pump CABG could be performed to reduce the stroke risk.
Keywords : Arteriosclerosis; off-pump coronary artery bypass grefting; internal carotid artery occlusion
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