Coronary artery bypass grafting in a patient with brainstem ischemia

We describe a 54-year-old male with severe coronary artery disease and cere brovascular disease including right cerebellar infarction, total occlusion of the bilateral vertebral arteries, brainstem. ischemia, and right cerebra l infarction with significant right carotid artery disease. Repeated percut aneous transluminal coronary angioplasty had been performed, however, unsta ble angina was developed despite maximal medical treatment. Coronary artery bypass grafting was successfully undergone with use of propofal, applicati on of the intraaortic balloon pumping perioperatively, and mad hypothermic cardiopulmonary bypass with alpha-stat blood gas management. The importance of preoperative evaluation of the intracranial circulation and management of cardiopulmonary bypass are discussed.