Severe Asymptomatic Carotid Artery Stenosis Treatment During Coronary Artery Bypass Surgery

Background: Although the prevalence of severe carotid artery disease (CAD) in patients undergoing coronary artery bypass grafting (CABG) is high, no clear consensus on how to manage these patients exists, especially in asymptomatic cases. We aimed to determine the impact of asymptomatic severe CAD on in-hospital stroke and all-cause mortality rates in patients undergoing CABG. Methods: We retrospectively analyzed 235 patients with documented carotid duplex ultrasound before undergoing isolated CABG at our institution between August 2015 and December 2022. To assess the rates of stroke and mortality after CABG, patients with severe CAD were compared with those without. Staged or concomitant carotid revascularization was considered in patients with severe bilateral CAD or a poor collateral brain network. Results: Patients with severe CAD were significantly older with a higher prevalence of CAD treatment history. Although their intensive care unit stay was longer, other postoperative complications were not significant. Among all patients, only one occurrence of 30-day mortality was observed, and patients with severe CAD had similar rates of postoperative stroke and death to those without. Postoperative stroke was related to carotid artery lesions in 2 patients with severe CAD but not in 9 patients without. Carotid artery stenting (CAS) was successfully performed without cerebral complications. Conclusions: Coronary artery bypass grafting in selected patients with severe asymptomatic CAD is acceptable and favorable; however, stroke related to severe CAD can occur after CABG. The decision to perform prophylactic or subsequent revascularization must be personalized and based on clinical judgment; however, close follow-up is required for patients with severe asymptomatic CAD. Furthermore, to prevent perioperative cerebrovascular events, preoperative carotid evaluation with a duplex ultrasonography scanner appears important.