Volume 48, Issue 4 December 2024 JVU 484-205 | Severe Asymptomatic Carotid Artery Stenosis Treatment During Coronary Artery Bypass Surgery-JVU 484-205 | Severe Asymptomatic Carotid Artery Stenosis Treatment During Coronary Artery Bypass Surgery

JVU 484-205 | Severe Asymptomatic Carotid Artery Stenosis Treatment During Coronary Artery Bypass Surgery

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The study conducted by Sugiyama et al., published in the Journal for Vascular Ultrasound, investigates the impact of asymptomatic severe carotid artery disease (CAD) on in-hospital stroke and all-cause mortality rates in patients undergoing isolated coronary artery bypass grafting (CABG). Conducted at Aichi Medical University Hospital from 2015 to 2022, the researchers retrospectively analyzed 235 patients who had preoperative carotid duplex ultrasound. Among these patients, those with severe CAD were compared to those without to assess stroke and mortality rates post-CABG. <br /><br />Findings illustrate that patients with severe CAD had similar rates of postoperative stroke and death compared to those without, despite severe CAD patients being older and having a longer intensive care unit stay. Notably, carotid artery stenting (CAS) was effectively performed in these patients without cerebral complications. The study emphasizes that meticulous preoperative evaluation and tailored clinical judgment are necessary, suggesting that severe asymptomatic CAD, when properly managed, does not substantially elevate the risk of perioperative stroke or mortality linked to CABG.<br /><br />The analysis identified that, although severe CAD was not a direct risk factor for adverse perioperative outcomes, the potential for stroke necessitates careful management and close follow-up. It advocates for the consideration of staged revascularization, especially in patients with significant bilateral CAD or a compromised cerebral collateral system. Moreover, routine preoperative screening of carotid arteries through duplex ultrasound is advised to mitigate long-term cerebrovascular events, solidifying the study's assertion that more comprehensive investigation into the optimal management of asymptomatic severe CAD in CABG patients is needed.<br /><br />This study contributes valuable insights into the clinical management of patients with concurrent severe CAD and coronary artery disease and highlights the practicality and safety of selective revascularization strategies.

Keywords

asymptomatic severe carotid artery disease

coronary artery bypass grafting

in-hospital stroke

all-cause mortality

carotid duplex ultrasound

carotid artery stenting

perioperative outcomes

revascularization strategies

cerebrovascular events

clinical management