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Ann Thorac Surg 2008;85:519. doi:10.1016/j.athoracsur.2007.10.021
© 2008 The Society of Thoracic Surgeons
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Original Articles: Cardiovascular

Invited Commentary

Antonio Calafiore, MD

Cardiac Surgery, University of Catania, Ferrarotto Hospital, Via Citelli, Catania 95124, Italy

(Email: calafiore{at}unich.it).

This study [1] reports results of great interest for the correct surgical treatment of coronary artery disease. The authors had the unique opportunity to use sophisticated tools to explore the hemodynamic impact of asymptomatic carotid stenosis, as well as the possibility to investigate the intracranial cerebral perfusion. In addition to epiaortic scanning, the authors had all the information necessary to titrate the correct strategy for the single patient. The results they obtained were outstanding: a stroke incidence of 0.4% and no disabled patient 3 months after surgery. Are these results reproducible? I am afraid they are not. In the real world many healthcare systems are ruled by the principle of cost to benefit ratio, and the price to avoid a single stroke implies a global screening with huge investments in term of resources. Other healthcare systems are essentially private. Unfortunately, we believe that the purpose of insurance companies is never the health of the insured people, but the profit. In this difficult situation, the authors are to be commended for the high quality of care they gave to their patients. The sequelae of a stroke can forever change a life and can impair the results of any operation, even when perfectly performed.


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  1. Nakamura M, Okamoto F, Nakanishi K, et al. Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? Ann Thorac Surg 2008;85:513-519.[Abstract/Free Full Text]

Related Article

Does Intensive Management of Cerebral Hemodynamics and Atheromatous Aorta Reduce Stroke After Coronary Artery Surgery?
Masanori Nakamura, Fumiyuki Okamoto, Katsuhiko Nakanishi, Ryushi Maruyama, Akira Yamada, Satoshi Ushikoshi, Shunsuke Terasaka, Satoshi Kuroda, Keisuke Sakai, and Tetsuya Higami
Ann. Thorac. Surg. 2008 85: 513-519. [Abstract] [Full Text] [PDF]




This Article
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Antonio Calafiore
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Right arrow Cerebral protection
Right arrow Coronary disease
Right arrowRelated Article

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