Combined innominate artery reconstruction and coronary artery bypass grafting

Two patients having significant coronary artery disease with innominate artery near-total occlusion presented neurological deficit of syncope events or cerebellar and brain stem infarct. Both of them were successfully treated with one-stage reconstruction combined with aorto-carotid-subclavian bypass and coronary artery bypass grafting (CABG). While it could not be over-emphasized how to protect both myocardium and cerebrum during CABG, cerebral perfusion through the reconstructed carotid bypass graft is the key maneuver during cardiac arrest and moderate hypothermia. Hypoperfused cerebral hemispheres were both improved extensively in the follow-up angiography. The absence of cerebral deficit and the free from coronary angina suggested that surgical technique to combine innominate with coronary artery surgery is feasible with acceptable mortality and morbidity rate.