Staged coronary artery bypass grafting after percutaneous angioplasty for intracranial vascular stenosis

Objective: Cerebrovascular disease is commonly associated with coronary art ery disease and is a major risk factor for cardiac surgery. Concomitant cor onary artery bypass grafting and carotid endarterectomy may reduce the risk of stroke; however, this staged operation is effective only for extracrani al lesions. The strategy for on-pump coronary artery bypass grafting for pa tients with intracranial vascular stenosis is still controversial. Methods: The subjects were 157 consecutive candidates for coronary artery b ypass grafting who underwent computed tomography and digital subtraction ce rebral angiography preoperatively to check for cerebrovascular disease. Add itional single-photon emission computed tomography was performed to evaluat e cerebral ischemia, according to the neurologist's request. Patients with diffuse intracranial vascular stenosis impossible to treat with percutaneou s transluminal angioplasty underwent off-pump coronary artery bypass grafti ng. Patients with a circumflex coronary artery lesion first underwent percu taneous transluminal angioplasty for cerebral vascular stenosis followed by secondary on-pump coronary artery bypass grafting. Results: Three patients were selected for staged operations. Percutaneous t ransluminal angioplasty was performed for 4 intracranial stenotic lesions. All lesions were dilated successfully, and no complications developed durin g or after the procedure. All patients tolerated staged coronary artery byp ass grafting and were extubated within 1 day without any mental disturbance . No further neurologic complication occurred, and computed tomography perf ormed postoperatively revealed no significant changes. Conclusion: Staged on-pump coronary bypass after percutaneous transluminal angioplasty for cerebrovascular disease may reduce the risk of stroke durin g cardiopulmonary bypass, and it is useful especially in patients with intr acranial cerebrovascular disease.