Volume 14, Issue 4 (9-2026)
J Surg Trauma 2026, 14(4): 224-227 |
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Taherinezhad Ledari A, Ganjifard* M, Hosseini Zargaz S E, Amouzeshi A. Cardiopulmonary Bypass Management in A Patient with Unilateral 100% Internal Carotid Artery Stenosis and Prior Stroke: A Case Report. J Surg Trauma 2026; 14 (4) :224-227
URL: http://jsurgery.bums.ac.ir/article-1-548-en.html
URL: http://jsurgery.bums.ac.ir/article-1-548-en.html
Department of Cardiology, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
Abstract: (416 Views)
Abstract
Carotid artery stenosis is a major risk factor in open-heart surgery, significantly increasing the incidence of postoperative neurological complications and disabilities. Depending on the stenosis severity, this condition can exacerbate the risk of stroke and neurological dysfunction during cardiopulmonary bypass (CPB). The management of such patients necessitates strategic approaches in perfusion and physiological management to maintain adequate cerebral blood flow.The patient, a 69-year-old male with a history of myocardial infarction, was a candidate for coronary artery bypass grafting (CABG). Preoperative assessments revealed a complete occlusion of the internal carotid artery. Given the involvement of three major coronary vessels, the patient underwent on-pump open-heart surgery. The primary challenge was balancing cerebral perfusion pressure and acid-base management.Throughout the CPB procedure, the perfusion team employed a combination of Alpha-stat and pH-stat strategies intermittently and at strategic times. This approach aimed to maintain cerebral autoregulation while preventing significant alterations in blood carbon dioxide levels. Through this advanced management, the patient was closely monitored and navigated the critical phases of the surgery successfully.
The patient was transferred to the intensive care unit postoperatively without any neurological sequelae or exacerbated cerebral complications and was eventually discharged in stable condition. This case demonstrates that although carotid stenosis poses a potential risk for neurological sequelae, the judicious integration of pH-stat and Alpha-stat strategies can effectively control and reduce the rate of cerebral ischemic complications during and after open-heart surgery.
Carotid artery stenosis is a major risk factor in open-heart surgery, significantly increasing the incidence of postoperative neurological complications and disabilities. Depending on the stenosis severity, this condition can exacerbate the risk of stroke and neurological dysfunction during cardiopulmonary bypass (CPB). The management of such patients necessitates strategic approaches in perfusion and physiological management to maintain adequate cerebral blood flow.The patient, a 69-year-old male with a history of myocardial infarction, was a candidate for coronary artery bypass grafting (CABG). Preoperative assessments revealed a complete occlusion of the internal carotid artery. Given the involvement of three major coronary vessels, the patient underwent on-pump open-heart surgery. The primary challenge was balancing cerebral perfusion pressure and acid-base management.Throughout the CPB procedure, the perfusion team employed a combination of Alpha-stat and pH-stat strategies intermittently and at strategic times. This approach aimed to maintain cerebral autoregulation while preventing significant alterations in blood carbon dioxide levels. Through this advanced management, the patient was closely monitored and navigated the critical phases of the surgery successfully.
The patient was transferred to the intensive care unit postoperatively without any neurological sequelae or exacerbated cerebral complications and was eventually discharged in stable condition. This case demonstrates that although carotid stenosis poses a potential risk for neurological sequelae, the judicious integration of pH-stat and Alpha-stat strategies can effectively control and reduce the rate of cerebral ischemic complications during and after open-heart surgery.
Type of Study: Case Report |
Subject:
Heart Surgery
Received: 2026/03/8 | Accepted: 2026/06/15 | ePublished ahead of print: 2026/07/11 | Published: 2026/09/1
Received: 2026/03/8 | Accepted: 2026/06/15 | ePublished ahead of print: 2026/07/11 | Published: 2026/09/1
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