SUCCESSFUL REVASCULARIZATION FOR UNSTABLE ANGINA OF A PATIENT WITH ASYMPTOMATIC BILATERAL INTERNAL CAROTID OCCLUSION, 70-PERCENT STENOSES OF THE EXTERNAL CAROTID ARTERIES, AND OTHER CIRCULATION DISTURBANCES

Nowadays, advanced surgical and anaesthesiological techniques of coron ary artery bypass grafting minimize the risk of severe complications i n patients with advanced arteriosclerotic cerebrovascular disease. Nev ertheless, in case of highly compromized cerebrovascular status, the d ecision whether to undertake coronary artery bypass grafting or not re quires special patient-related consideration. A severe, unstable angin a made it necessary to perform coronary bypass grafting in a patient w ith bilateral internal carotid occlusion, a bilateral mid-stage stenos is of both external carotid arteries, a diminished flow within the rig ht vertebral artery, and a subsequently impaired intracranial blood fl ow. Intraoperatively, besides the usual hemodynamic measurements, lase r-Doppler flow probes were placed on the left and right upper temple t o monitor relative changes of the cerebral blood supply. Using an indi vidual perioperative management, the patient experienced a normal post operative course and was discharged in good condition.