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Trans-Atlantic debate: is carotid artery disease responsible for perioperative strokes after coronary artery bypass surgery?

T. Forbes,J. Ricco

Published 2010 in European Journal of Vascular and Endovascular Surgery

ABSTRACT

The coronary and extracranial carotid vascular beds are often simultaneously affected by significant atherosclerotic disease, and stroke is one of the potential major complications of coronary artery surgery. As a result, there is no shortage of reports in the vascular surgery literature describing simultaneous coronary and carotid artery revascularizations. Generally these reports have found this combination of operations safe, but have stopped short of proving that it is necessary. Intuitively, simultaneous carotid endarterectomy and coronary artery bypass surgery could be justified if the majority of perioperative strokes were the result of a significant carotid stenosis, either directly or indirectly. At first glance this appears to be a fairly straight forward issue, however much of the evidence on both sides of the argument is circumstantial. One significant problem in analyzing outcome by choice of treatment in patients presenting with both coronary and carotid disease is the multiple potential causes of stroke in coronary bypass patients which include hemorrhage, and atheroemboli from aortic atheromas during clamping. But this controversial subject is now open to discussion and our

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