Cerebrovascular stenosis and mortality after isolated off-pump coronary artery bypass grafting
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Updated: Oct 31, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
YuKang Pei1, Chen Bai1, JianGang Wang2,3
1Department of Valve and Atrial Fibrillation Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Background:
Cerebrovascular atherosclerosis is common in patients undergoing coronary revascularization. Although carotid artery disease has been extensively studied, the association between vertebral artery stenosis and long-term outcomes after isolated off-pump coronary artery bypass grafting (OPCABG) remains uncertain.
Methods:
We performed a retrospective cohort study of consecutive patients undergoing isolated OPCABG at a tertiary cardiac center between January 2018 and July 2021. Preoperative bilateral carotid and vertebral artery duplex ultrasonography was reviewed. Severe cerebrovascular stenosis was defined as 70%-99% luminal narrowing or complete occlusion involving at least one extracranial carotid or vertebral artery. The primary outcome was long-term all-cause mortality. Kaplan-Meier analysis and multivariable Cox proportional hazards regression were used to evaluate associations with mortality. In-hospital postoperative cerebral infarction and 30-day all-cause mortality were additionally summarized.
Results:
Among 1,277 patients, 186 (14.6%) had severe cerebrovascular stenosis, including 100 with severe carotid disease and 109 with severe vertebral disease; 23 patients had both. During a median follow-up of 4.79 years, 87 deaths occurred. Severe carotid stenosis was associated with worse unadjusted survival (log-rank P = 0.028) but was not independently associated with mortality after multivariable adjustment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 0.86-2.13; P = 0.196). Severe vertebral stenosis (HR, 1.86; 95% CI, 1.22-2.84; P = 0.004) and any severe cerebrovascular stenosis (HR, 1.69; 95% CI, 1.21-2.37; P = 0.002) were independently associated with mortality. In-hospital postoperative cerebral infarction (5.91% vs. 0.55%; P < 0.001) and 30-day mortality (4.84% vs. 1.65%; P = 0.011) were more frequent among patients with severe cerebrovascular stenosis.
Conclusions:
Severe cerebrovascular stenosis was associated with increased long-term mortality after isolated OPCABG. Severe vertebral artery stenosis showed the strongest association and may represent a marker of more extensive systemic atherosclerotic disease. These findings support consideration of both carotid and vertebral territories during preoperative vascular assessment, while prospective studies are needed to determine clinical utility.
