[Severe Carotid Artery Disease;Preoperative Assessment and Perioperative Management]
Kaoru Matsuura1, Goro Matsumiya
1Department of Cardiovascular Surgery, Chiba University, Chiba, Japan.
Insights
Cerebrovascular complications after open heart surgery are serious. Non-invasive carotid doppler echo screening effectively identifies carotid artery stenosis, a common issue in coronary artery disease patients, aiding prevention strategies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Cerebrovascular complications significantly reduce quality of life post-open heart surgery.
- Carotid artery stenosis is prevalent in patients with coronary artery disease, particularly those with complex lesions.
- Increasing complexity of coronary artery bypass grafting (CABG) cases correlates with higher rates of carotid artery lesions.
Purpose of the Study:
- To highlight the effectiveness of carotid doppler echo as a non-invasive screening tool for carotid artery stenosis.
- To emphasize the link between coronary artery disease complexity and carotid artery stenosis.
- To discuss management strategies for significant carotid artery stenosis in patients undergoing open heart surgery.
Main Methods:
- Utilizing carotid doppler echo for non-invasive screening of carotid artery stenosis.
- Reviewing literature on the association between coronary artery disease and carotid artery lesions.
- Analyzing mechanisms of cerebral infarction caused by carotid artery stenosis (emboli and low perfusion).
Main Results:
- Carotid doppler echo is an effective non-invasive modality for screening carotid artery stenosis.
- Significant carotid artery stenosis requires multidisciplinary team consideration for intervention (endarterectomy or stenting).
- Avoiding atheromatous emboli and low perfusion pressure is crucial during open heart surgery.
Conclusions:
- Early detection and management of carotid artery stenosis are vital for reducing cerebrovascular complications after open heart surgery.
- Non-invasive screening methods like carotid doppler echo play a key role in patient management.
- Preventive strategies targeting emboli and perfusion pressure are essential in open heart procedures.
Abstract:
Cerebrovascular complication is the one of the most dreadful complication after open heart surgery which leads to significant decrease of quality of life even if the patients survived. To decrease these complications, carotid doppler echo as one of the non-invasive carotid screening modalities is effective. Carotid artery stenosis is common in the patients with coronary artery disease, and it is more frequent in the patients with more complexed coronary artery lesions. The more the patients indicated for coronary artery bypass grafting has complexed lesions these days, the more the patients have carotid artery lesions. In case of presence of significant carotid artery stenosis with symptom, carotid artery intervention, either carotid endarterectomy or carotid artery stenting, should be considered by multidisciplinary team. The carotid artery stenosis could cause cerebral infarction by 2 major mechanisms, which are emboli, and low perfusion pressure. In open heart surgery, it is very important to avoid these occasions. Although It is still controversial whether off-pump coronary artery bypass grafting is superior to conventional on-pump coronary artery bypass grafting in randomized trial, it is necessary in common to avoid atheromatous emboli from aorta and to avoid low perfusion pressure by all means.
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