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Washington University Experience | VASCULAR | Aneurysm - Saccular | 1A0 Case 1 History
Case 1 History ---- The patient was 54 year old man with a medical history significant for poorly-controlled hypertension, hyperlipidemia, peripheral vascular disease and recurrent pancreatitis (last episode 11/04). Approximately one year before the current admission, the patient began to have syncopal episodes. Work-up showed bilateral carotid artery occlusion, coronary artery disease and renal artery stenosis. He underwent left renal artery stenting on 4/20/05 and left subclavian-to-left carotid bypass with left carotid endarterectomy on 4/21/05. Following the endarterectomy procedure, the patient was noted to have left facial droop and left tongue deviation. Computed tomography showed a 2 cm calcified right middle cerebral artery aneurysm. Neurosurgery was consulted, and their opinion was that the patient's severe coronary artery disease should be addressed before surgery on the cerebral aneurysm. Therefore, the patient presented on 5/19/05 for coronary artery bypass grafting. The patient received a single reverse saphenous vein graft of the left anterior descending artery on 5/20/05. After the completion of the operation, the patient required increasing inotropic support. An intra-aortic balloon pump was placed; however, the patient continued to deteriorate. His chest was re-opened. Acute cardiac life support was attempted for 45 min, at which point the decision was made to re-direct care. The patient was pronounced dead on 5/20/05.
