Abstract Body: Objective：To investigate the epidemiology of carotid-cerebral artery disease in coronary artery bypass grafting (CABG) patients and explore the influence of different degrees of carotid-cerebral artery disease on postoperative neurological complications.
Method：We prospectively collected and analyzed 1002 consecutive patients who underwent CABG between March 2020 to November 2022 in our single center. Computed tomography angiography (CTA) was performed preoperatively. Patients were then divided into two cohorts with or without carotid-cerebral artery disease (defined as stenosis of any carotid, vertebral or intracranial artery≥50%). The primary outcome was the early neurological complications (within 7 days post-CABG), defined as a composite of stroke, delayed awakening (≥48h after withdrawing sedative), and severe delirium (ICU CAM-II score≥2).
Results：Of the overall 1002 patients, the most susceptible arteries of stenosis≥50% were internal carotid artery(34.2%, 686/2004). vertebral artery (19.5%, 390/2004). and common carotid artery (17.3%, 347/2004). Basilar artery (2.3%, 23/1002) was the least affected. Extracranial lesions were present in 77.9%(781/1002) of patients, intracranial lesions in 35.7%(358/1002) and both intracranial and extracranial lesions in 32.2%(323/1002). Early neurological complications post-CABG occurred in 104 patients (10.4%), including 16(1.6%) with stroke, 45(4.5%) with delayed awakening and 60(6.0%) with severe delirium. Patients with carotid-cerebral artery disease had a higher risk of appearing early neurological complications (risk ratio [RR], 2.09; 95% CI, 1.39-3.13), stroke (RR, 3.66; 95% CI, 1.05-12.78), delayed awakening (RR, 1.87; 95% CI, 1.01-3.48), severe delirium (RR, 1.97; 95% CI, 1.15-3.38). Patients with carotid-cerebral artery disease still increased the risk of early neurological complications (adjusted RR, 1.66; 95% CI, 1.10-2.51) after adjustment possible confounders. As the degree of carotid-cerebral artery disease increased, there was a statistically significant linear upward trend in the incidence of all primary outcomes (P<0.05 for all).
Conclusions：The combined carotid-cerebral artery disease was common in CABG patients, with the internal carotid artery, vertebral artery and common carotid artery being the most susceptible. Patients with carotid-cerebral artery disease was independently causally associated with early neurological complications after CABG.