Carotid disease is a risk factor for stroke in coronary bypass operations

The purpose of this study was to investigate the risk of perioperative majo r cerebrovascular events (MCVEs) in patients undergoing coronary artery byp ass grafting (CABG) and to develop preventive therapy. After excluding the patients with marked ascending aortic atheromas and those with combined int racardiac procedures such as valve replacement and aneurysmectomy, 722 cons ecutive patients who had carotid artery duplex scanning (CADS) and CABG wer e studied. The results of the study showed the correlation of advanced age, smoking, previous major cerebrovascular event (MCVE), and severe coronary artery disease with high grade carotid artery stenosis of 80-99% (p < 0.05) . A total of 13 patients had perioperative MCVE and an analysis of risk fac tors showed that the MCVE correlated with carotid stenosis of > 60% and red uced cardiac output requiring inotropic support (p < 0.01). Prophylactic ca rotid endarterectomy (CEA) in patients with 80% to 99% carotid stenosis not ably decreased the incidence of MCVE (p < 0.01), and the use of the "pump o ff" technique instead of standard cardiopulmonary bypass decreased MCVE (p = 0.056). On the basis of these data, prophylactic carotid endarterectomy i s effective in averting perioperative MCVE in subjects with carotid stenosi s of 80% to 99%, and for those with 60% to 79% carotid stenosis, the pump o ff technique decreases MCVE.