Are small and moderate stenosis of carotid arteries the risk factors for cerebrovascular complications in patients in coronary artery bypass grafting?

Abstract

Currently, a surgical intervention can not be evaluated as a successful one if a patient develops cerebrovascular
complications after the surgery. This literature review presents the modern data on clinical and functional features of a combined atherosclerotic lesion of coronary and carotid arteries, incidence of detection and their prognostic value. Also, current studies designed to identify the causes of development, the pathogenesis and to prevent the development of these complications in cardiosurgical patients are analyzed. The role of small and moderate stenoses of carotid arteries and their impact on the development of cerebrovascular complications of coronary artery bypass grafting are reviewed. It is discussed that the patients with small and moderate stenoses are more vulnerable in cardiosurgical
interventions as compared to the patients without stenotic lesion of carotid arteries. An additional reason for the
development of cerebrovascular complications in these patients is that initially they have a more pronounced violation of a cerebral blood flow autoregulation which ensures the brain resistance to the episodes of acute ischemia and hypoperfusion in arterial blood pressure changes during the surgery, than in patients without stenosis. A combination of low heart contractility and a low cerebrovascular reserve increases the risk of complications development in this cohort of patients.