背景：冠心病（coronary artery bypass grafting, CABG）合并颈动脉狭窄者临床上并不少见。如何正确处理CABG患者并存颈动脉狭窄的问题应引起重视。目的：为了探索CABG患者并存颈动脉狭窄的最佳处理方法，本文将CABG患者并存颈动脉狭窄的外科治疗及麻醉处理进行了分析汇总。内容：对于合并颈动脉狭窄的冠心病患者，最佳治疗策略尚未达成共识。既往外科治疗多采用分期或同期颈动脉内膜剥脱术（carotid endarterectomy, CEA），但近年来随着经皮介入治疗技术的发展，大多数可以采用分期或同期经皮颈动脉支架置入术（carotid artery stenting, CAS）。冠心病合并颈动脉狭窄患者围术期麻醉处理的关键是维持血流动力学平稳，保证大脑的有效灌注压，避免脑缺血和栓塞。趋向：同日CAS-CABG“杂交”手术已显示出可行性，并有待进一步研究。
Background: Patients undergoing coronary artery bypass grafting (CABG) concomitant with carotid stenosis are very common in clinic. It is significant to optimally manage patients with carotid stenosis who are scheduled for CABG. Purpose: In order to pursue optimal methods to manege patients with carotid stenosis who are scheduled for CABG, this article has reviewed surgical treatment and perioperative anesthetic management of patients undergoing CABG concomitant with carotid stenosis. Content: Optimal management of patients with combined coronary and carotid artery disease remains controversial. Staged or combined carotid endarterectomy (CEA) and CABG were generally adopted in the past. Recently, with the development of percutaneous intervention techniques, many patients can undergo staged or combined carotid artery stenting (CAS) and CABG. The key points to deal with patients undergoing CABG concomitant with carotid stenosis are maintaining hemodynamic stabilization, in order to ensure efficient perfusion to brain and to avoid cerebral ischemia or embolism. Trend: Same-day hybrid revascularization by carotid stenting and CABG is feasible and needs further research.
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