Surgical strategies in patients at high risk for stroke undergoing coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Perioperative stroke is a significant complication of coronary artery bypass grafting (CABG).
• Patients with aortic atherosclerosis or carotid disease face elevated stroke risk during CABG.
• An individualized surgical strategy was investigated to mitigate neurological injury in these high-risk patients.

Purpose of the Study:

• To evaluate an individualized surgical approach for reducing neurological injury in CABG patients.
• To assess the impact of tailored surgical techniques on stroke incidence in high-risk populations.
• To determine if preoperative and intraoperative screening aids in preventing adverse neurologic sequelae.

Main Methods:

• 6,138 patients undergoing elective CABG were assessed using intraoperative transesophageal echocardiography and preoperative carotid artery screening.
• Surgical techniques were individualized based on findings, including hypothermic circulatory arrest with aortic atherectomy, off-pump CABG, and minimally invasive approaches.
• Patients were categorized into low-risk, aortic atheromatous disease (A.ATH), carotid disease (CD), and combined (CD + A.ATH) groups.

Main Results:

• Stroke incidence was 0.92% in the low-risk group (n=5,043) and 0.96% in the A.ATH group (n=918).
• The CD group (n=166) had a 0.6% stroke incidence.
• Notably, the CD + A.ATH group (n=11) experienced a 0% stroke incidence.

Conclusions:

• Preoperative and intraoperative screening effectively identifies patients with extensive aortic and carotid atherosclerosis.
• Selective application of individualized surgical techniques in high-risk patients prevents neurologic complications.
• This approach achieves complete myocardial revascularization while minimizing stroke risk.