Immediate results (during hospitalization)
There weren’t fatal cases registered during hospitalization. In total, 6
(2.5%) neurological complications’ cases and 3 (1.2%) acute MI cases
were registered: in the simultaneous interventions’ group, 3 (2.9%)
ACVA and 1 (0.9%) MI, in the group with the first stage of CABG - 2
(2.0%) ACVA, 1 (1.0%) TIA and 1 (1.0%) MI, in the group with the
first stage of CEA - 1 (2.7%) ACVA. The groups had similar combined
results - 4 (3.9%) for the group with the first stage of CABG, 1
(2.7%) for the group with the first stage of CEA and 4 (3.8%) for the
combined group. There wasn’t significant difference in any endpoints
(Table III).
All ACVA cases occurred by the time the patient woke up after surgery.
In the combined interventions’ group, in one case ACVA appeared in the
middle cerebral artery basin from the operated side. Given the
reconstruction zone patency according to MSCT AG BCA(brachiocephalic
arteries), the complication is probably associated with ischemia during
the carotid arteries compression. The second and third ACVA cases
manifested themselves in the posterior cerebral artery basin. Acute
antero-lateral MI in the combined group was recorded on the fourth day
after mammarocoronary bypass surgery and CEA on the right in a patient
with right coronary artery chronic occlusion and diffuse critical lesion
of the envelope artery throughout. Angiography was performed – mammary
graft is passable.
In the stage-by-stage interventions’ group, both ACVA cases in the
affected carotid artery basin were recorded in the early postoperative
period in patients who underwent CABG at the first stage. One patient
had TIA in the affected carotid artery pool on the third day after CABG.
All patients underwent CEA on average one month after the first stage.
One patient had a acute MI clinic along the anterior-lateral wall on the
second day after the first stage of the CEA. According to emergency
indications, CABG was performed. In the staged interventions’ group with
the first stage of CABG, in one case, ischemia along the anterior wall
occurred on the first day after surgery. According to the angiography,
an occlusion of the mammary graft was revealed. Given the anterior
descending artery diffuse lesion to the periphery, there are high risks
of repeated revascularization - acute MI was conservatively conducted.