Concomitant Carotid-Cerebral Artery Disease and Early Neurologic Complications After Coronary Artery Bypass Grafting

<h2>Abstract</h2><h3>Background</h3> Neurologic complications represented by stroke are one of the most terrible complications of coronary artery bypass grafting (CABG). We aimed to investigate the association between concomitant carotid-cerebral artery disease and major neurologic complications after CABG. <h3>Methods</h3> A cohort study of consecutive patients undergoing CABG from March 2020 to November 2022 in our single center was registered (NCT05036044) and conducted. Preoperative computed tomography angiography was used to identify carotid-cerebral artery disease, defined as any carotid, vertebral, or intracranial artery with stenosis ≥50%. The primary outcome was early major neurologic complications within 7 days after CABG, a composite of stroke, delayed awakening (≥48 hours after withdrawal of sedative), and severe delirium (Confusion Assessment Method of Intensive Care Unit II score ≥2). <h3>Results</h3> A total of 1002 patients were enrolled (mean age, 65.0 ± 9.6 years; 19.7% female). Early major neurologic complications 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 early major neurologic complications (adjusted risk ratio [RR], 1.66; 95% CI, 1.10-2.51; <i>P</i> = .015), represented by stroke (RR, 2.78; 95% CI, 0.78-9.90), delayed awakening (RR, 1.67; 95% CI, 0.96-2.89), and severe delirium (RR, 1.44; 95% CI, 0.76-2.70). A stepwise increase in the incidence of all neurologic complications was observed with increasing severity of arterial stenosis (<i>P</i> < .05 for all). <h3>Conclusions</h3> Concomitant carotid-cerebral artery disease was associated with higher risk of early major neurologic complications after CABG, including stroke, delayed awakening, and severe delirium.