OFF-PUMP CABG FOLLOWING EXTERNAL CAROTID ARTERY STENTING IN A PATIENT WITH SEVERE CEREBROVASCULAR DISEASE

A 70-year-old man who had undergone bilateral STA-MCA bypass was hospitalized with unstable angina pectoris. Coronary angiography revealed triple vessel disease with left main trunk lesion. Selective cerebral angiography showed occlusion of the right common carotid artery, left internal carotid artery, and left vertebral artery. The left external carotid artery was 90% stenotic at its origin. Conventional combination of on-pump CABG and carotid endarterectomy was a high-risk procedure for this patient, so we conducted carotid artery stenting against left external carotid stenosis under local anesthesia 10 days before CABG. Off-pump CABG was done using a LITA graft to the LAD and SVG to the RCA branch. Postoperative coronary angiography confirmed good graft patency. The patient had a stable, uncomplicated postoperative course. Off-pump CABG following carotid artery stenting was less invasive than the conventional procedure and very beneficial to a patient with high-risk cerebral artery disease.