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Background: Intraoperative transit time flowmetry (TTF) is a crucial tool for assessing graft quality and functionality during off-pump coronary artery bypass grafting (OPCABG). This study evaluates the effectiveness of TTF in two groups of patients undergoing OPCABG: one with sequential grafts and the other with Y-grafts. Methods: A total of 120 patients with triple vessel disease were enrolled, patients were divided into two groups: group 1 (n=60) - sequential venous grafts (mean age 65.2 ± 8.4; males/females - 42/18); group 2 (n=60) - Yvenous grafts (mean age 64.8 ± 7.9; males/females - 40/20). The MBF and PI were measured with transit-time flow measurement (TTFM). We compared intraoperative graft failure rates using predefined criteria of pulsatility index (PI) less than 2.5 and flow greater than 15 ml/min as indicators of normal graft function. Sequential saphenous vein grafts were used to bypass the diagonal artery (Diagonal) (side-by-side) and/or, obtuse marginal artery (OM) (side-by-side) and Cx or PDA (end-to-side). Results: The mean MBF of the "single" vs. sequential graft to PDA was 45.3 ± 10.2 ml/min vs. 42.7 ± 11.1 ml/min mL/min (P=0.472). The PI of 'single graft' vs. sequential graft to PDA was 1.8 ± 0.4 vs. 2.0 ± 0.5 (P=0.941). There were 1 (1.7%) case of graft failure in group 1 and 2 (3.3%) cases of intraoperative graft failure in group 2 diagnosed using TTF. During 48 month follow-up (43 - Group 1 and 38 - Group 2) there were3 cases of graft occlusion in Y-graft group, whereas in sequential group all graft were patent. Conclusions: In conclusion, our study underscores the effectiveness of intraoperative transit time flowmetry (TTF) in assessing graft quality and functionality during off-pump coronary artery bypass grafting (OPCABG). The use of TTF provided critical real-time feedback on graft performance, enabling the detection and correction of potential graft failures intraoperatively. Our findings indicate that sequential grafts exhibit superior short-term and long-term patency compared to Y-grafts, with significantly lower intraoperative graft failure rates and better 48-month follow-up outcomes. The data supports the preference for sequential grafting techniques in OPCABG procedures to enhance graft patency and reduce the incidence of complications. Furthermore, the routine implementation of TTF should be considered essential for optimizing surgical outcomes and ensuring the longterm success of coronary artery bypass grafts. [ABSTRACT FROM AUTHOR]

More than ten international randomized trials have been conducted to determine the effectiveness and safety of carotid artery stenting and comparing the latter with the results of carotid endarterectomy. However, some of them obtained conflicting data confirming both the advantage of carotid stenting (SAPPHIRE) and carotid endarterectomy (EVA-3S), as well as the equivalence of the two treatments (CAVATAS, SPACE, CREST). Also, unsatisfactory results of both single-stage and staged surgical approaches were shown in the treatment of patients with combined atherosclerotic lesions of the coronary and carotid arteries. The lack of clear international guidelines for the management of patients with lesions of several vascular beds makes it necessary to look for new methods of surgical treatment based on minimally invasive endovascular technologies. This review article analyzes the results of randomized trials comparing the results of carotid endarterectomy and carotid stenting in patients with carotid atherosclerosis. [ABSTRACT FROM AUTHOR]