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.