BACKGROUNDCoexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.

METHODSBetween January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out.

RESULTSA total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5 +/- 7.0) minutes. The mean number of distal grafts per patient was 3.30 +/- 0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3 +/- 5.4) hours, (2.1 +/- 0.9) days, and (12.5 +/- 6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5 +/- 12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.

CONCLUSIONCombined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

Aged ; Carotid Artery Diseases ; surgery ; Coronary Artery Bypass, Off-Pump ; adverse effects ; methods ; Coronary Artery Disease ; surgery ; Endarterectomy, Carotid ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo explore the expression and changes of protooncogene c-myc in early restenosis after carotid endarterectomy (CEA).

METHODSUsing New Zealand Rabbits, carotid atherosclerotic stenosis (CASS) model were created. The expression of c-myc in early restenosis after CEA were detected by quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTSIn this experiment protooncogene c-myc was analysed at pre-operation, 4 hours and 1 d after CEA by qRT-PCR, and the level of mRNA of c-myc was reached maximum at 4 hours, and decreased following significantly, but still higher than pre-operation.

CONCLUSIONSThe activation of protooncogene c-myc may be generator factor of vascular smooth muscle cell proliferation.

Animals ; Carotid Arteries ; metabolism ; pathology ; surgery ; Carotid Artery Diseases ; surgery ; Carotid Stenosis ; etiology ; genetics ; physiopathology ; Disease Models, Animal ; Endarterectomy, Carotid ; adverse effects ; methods ; Gene Expression ; Male ; Postoperative Complications ; etiology ; metabolism ; physiopathology ; Proto-Oncogene Proteins c-myc ; genetics ; RNA, Messenger ; genetics ; metabolism ; Rabbits ; Random Allocation ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVE: The aim of this study was to examine the incidence of ischemia during protected carotid artery stenting (CAS) as well as to compare the protective efficacy of the balloon and filter devices on diffusion-weighted MR imaging (DWI). MATERIALS AND METHODS: Seventy-one consecutive protected CAS procedures in 70 patients with a severe (> 70%) or symptomatic moderate (> 50%) carotid artery stenosis were examined. A balloon device (PercuSurge GuardWire) and a filter device (FilterWire EX/EZ, Emboshield) was used in 33 cases (CAS-B group) and 38 cases (CAS-F group) to prevent distal embolization, respectively. All the patients underwent DWI within seven days before and after the procedures. The number of new cerebral ischemic lesions on the post-procedural DWI were counted and divided into ipsilateral and contralateral lesions according to the relationship with the stenting side. RESULTS: New cerebral ischemic lesions were detected in 13 (39.4%) out of the 33 CAS-Bs and in 15 (39.5%) out of the 38 CAS-Fs. The mean number of total, ipsilateral and contralateral new cerebral ischemic lesion was 2.39, 1.67 and 0.73 in the CAS-B group and 2.11, 1.32 and 0.79 in the CAS-F group, respectively. No statistical differences were found between the two groups (p = 0.96, 0.74 and 0.65, respectively). The embolic complications encountered included two retinal infarctions and one hemiparesis in the CAS-B group (9.09%), and one retinal infarction, one hemiparesis and one ataxia in the CAS-F group (7.89%). There was a similar incidence of embolic complications in the two groups (p = 1.00). CONCLUSION: The type of distal protection device used such as a balloon and filter does not affect the incidence of cerebral embolization after protected CAS.
Adult ; Aged ; Aged, 80 and over ; *Balloon Occlusion ; Blood Vessel Prosthesis Implantation/*instrumentation ; Brain Ischemia/*pathology ; Carotid Stenosis/*surgery ; *Diffusion Magnetic Resonance Imaging ; Endarterectomy, Carotid/adverse effects/methods ; Female ; Humans ; Intracranial Embolism/prevention & control ; Male ; Middle Aged ; Paresis/etiology ; Retinal Artery Occlusion/etiology ; Severity of Illness Index ; *Stents