Should severe monolateral asymptomatic carotid artery stenosis be treated at the time of coronary artery bypass operation?

Objective: The optimal treatment of severe monolateral asymptomatic carotid artery stenosis (SMACS) in patients undergoing coronary artery bypass graf ting (CABG) is still controversial. Materials and methods: This study is ba sed on the in-hospital and mid-term (>5 years) clinical results of a cohort of 139 consecutive CABG patients with SMACS operated at our Institution be tween January 1989 and December 1995. In the first 73 patients (no carotid surgery group), the SMACS was left untouched at the time of coronary surger y, whereas in the remaining 66 (carotid endoarterectomy group), the carotid stenosis was treated either immediately before or concomitantly with the C ABG procedure (depending on the severity of the anginal symptoms). Results: The overall preoperative characteristics of the patients were comparable. The in-hospital results were similar between the two groups with regard to mortality, stroke and major postoperative complications. However, at mid-te rm follow-up, significantly more patients of the no carotid surgery group s uffered cerebral events (transient or permanent) ipsilateral to the SMACS o r the lesion had to be operated on. Conclusions: The concomitant treatment (either staged or simultaneous) of SMACS at the time of CABG does not influ ence the in-hospital results, but confers significant neurological protecti on during the years after the operation. (C) 2001 Elsevier Science B.V. All rights reserved.