Coronary artery bypass grafting (CABG) is the "gold standard" for revascularization of left main diseased and/or complex multi-vessel diseased coronary artery disease. Post-CABG stroke is a relatively rare but catastrophic complication with a serious health and economic burden. In recent years, the further understanding of the concept of "panvascular disease", the implementation of the philosophy of "cardio-cerebral integrated treatment", and the improvement of related diagnostic and therapeutic techniques have provided new options for the recognition, prevention and cure of post-CABG stroke. Focusing on the key factor of carotid-cerebral artery disease, this review systematically scrutinizes the incidence, epidemiology, risk factors, mechanisms and prevention and treatment of post-CABG stroke. This review analyzes the association between post-CABG stroke and carotid-cerebral artery disease, summarizes the status of evidence-based prophylactic carotid-cerebral artery revascularization strategy, and prospects for future research directions.
ObjectiveTo evaluate the safety, efficacy, and advantages of transcarotid artery revascularization (TCAR) in patients with high-risk carotid artery stenosis. MethodsThe patient was a 76-year-old male with severe symptomatic stenosis of the right internal carotid artery, complicated by multiple high-risk factors (such as cardiac insufficiency, history of coronary stent implantation, aortic calcification). Given his unsuitability for carotid endarterectomy and the high perioperative risk associated with transfemoral carotid artery stenting, TCAR was performed. The procedure involved puncturing the common carotid artery via a small cervical incision to establish a temporary carotid-to-femoral venous reversed-flow pathway. Following balloon predilation, a stent was deployed, and the reversed-flow system was used to divert potential plaque debris outward, thereby reducing the risk of intraoperative cerebral embolism. ResultsThe procedure was completed successfully. The operation time was approximately 70 min, the estimated blood loss was 20 mL. Postoperatively, the patient did not experience complications such as stroke, neurological deficit, or hyperperfusion syndrome. Although carotid sinus reflex-induced hypotension occurred, which stabilized after pharmacological management. The results of following-up at 3 months showed the stent was patent with no evidence of in-stent restenosis. ConclusionsThe findings of this case indicate that TCAR combines the cerebral protection advantages of carotid endarterectomy with the minimally invasive features of transfemoral carotid artery stenting. Its reversed-flow mechanism helps effectively prevent intraoperative embolism, offering a safe and viable revascularization option for patients with high-risk carotid artery stenosis.
