[Off-pump coronary artery bypass grafting supported by intra-aortic balloon pumping in a patient with moyamoya disease].

A 48-year-old woman was admitted to the hospital for coronary artery bypass grafting (CABG) of ischemic coronary disease, including left main trunk disease. She had a history of moyamoya disease with bilateral internal carotid artery occlusion. Her cerebral blood flow and cerebral vascular reactivity were evaluated by single photon emission computed tomography. Her collateral blood flow and cerebral vascular reserve were the lower limit of normal. We performed off-pump CABG supported by intra-aortic ballon pumping to maintain appropriate cerebral blood flow intraoperatively. Moreover, during operation, systolic blood pressure and blood Paco2 level were constantly maintained above 100 mmHg and 40 mmHg. Her postoperative course was uneventful without transient ischemic attacks or stroke.