Carotid Artery Disease in Cardiac Surgery

Cardiac Surgery in Patients with Carotid Artery Disease is a powerful blend of storytelling and surgical science. Opening with the story of Mr. Shah — a patient whose routine preoperative evaluation reveals a hidden carotid bruit — the chapter transforms a common finding into a compelling lesson on decision-making, risk, and multidisciplinary coordination.

From this narrative, the discussion unfolds into the epidemiology and pathophysiology of carotid disease among cardiac patients, where atherosclerosis becomes the silent link between coronary and cerebrovascular risk. The text guides the reader through modern screening strategies, stroke mechanisms, and the ongoing dilemma of timing — heart first or brain first?

Evidence-based summaries from AHA/ACC (2022), ESC/EACTS (2018), SVS (2023), and STS (2021) guidelines are presented in a practical context, helping surgeons navigate between carotid endarterectomy, stenting, or isolated CABG. The chapter further details intraoperative perfusion management, emphasizing optimal cerebral oxygenation, pressure targets, temperature control, and the role of near-infrared spectroscopy in monitoring cerebral safety.

Written in an engaging narrative voice, the chapter bridges clinical reasoning and technical execution. It reminds the reader that cardiac surgery is not confined to the heart — it protects the brain, preserves function, and safeguards identity.

Ideal for cardiac surgery fellows, trainees, and practicing clinicians, this chapter delivers both academic depth and clinical wisdom, reflecting the art of balanced decision-making in complex, real-world cardiac practice.