Carotid Plaque‐Reporting and Data System for Predicting In‐Hospital Ischemic Stroke After Coronary Artery Bypass Graft‐Containing Cardiac Surgery: Complementary Value Beyond Stenosis Severity

Background Although carotid atherosclerosis is a recognized risk factor, the relationship between plaque characteristics and clinical outcomes after cardiac surgery remains unclear. Methods We retrospectively studied 1087 patients undergoing coronary artery bypass graft‐containing cardiac surgery between January 2023 and January 2024. Preoperative carotid ultrasound was used to assign Carotid Plaque‐Reporting and Data System (Plaque‐RADS) grades 1 to 4. The primary outcome was in‐hospital ischemic stroke. Given the low number of events, associations were evaluated using Firth penalized logistic regression with limited covariate adjustment. Results In‐hospital ischemic stroke occurred in 14 patients (1.3%). Stroke incidence increased across Plaque‐ RADS grades from 0% in grade 1 to 0.6%, 2.0%, and 6.3% in grades 2, 3, and 4, respectively ( P =0.011). Higher Plaque‐ RADS grade was associated with greater odds of in‐hospital ischemic stroke after adjustment for age, sex, surgical procedure, operative time, and aortic atherosclerotic burden ( odds ratio per 1‐grade increase, 4.31 [95% CI , 1.72–11.43]; P =0.002). The association was directionally similar among patients with carotid stenosis <50%. In exploratory discrimination analyses, the model including both stenosis and Plaque‐ RADS had the highest numerical area under the receiver operating characteristic curve , although the incremental gain over either individual parameter was modest. Conclusions Higher ultrasound‐based Plaque‐RADS grade was associated with in‐hospital ischemic stroke after coronary artery bypass graft‐containing cardiac surgery. Plaque‐RADS may provide complementary risk information. These findings should be considered hypothesis generating and require validation in larger prospective cohorts.