Cardiac surgery, carotid stenosis, and stroke prevention

Stroke following cardiac surgery is a major source of morbidity and mortality. In patients undergoing cardiac surgery, the presence of severe carotid stenosis is associated with a higher incidence of postoperative stroke. Carotid revascularization procedures, such as carotid endarterectomy and stenting, are frequently performed under such circumstances in an effort to reduce the incidence of stroke. The available literature suggests that most postoperative strokes are not directly related to carotid stenosis. Synchronous carotid revascularization and cardiac surgery renders a higher risk of cardiovascular complications. In this article, we summarize the incidences of postoperative stroke and carotid stenosis in this population, discuss the pathogenesis of stroke in these patients, and propose strategies for managing patients undergoing cardiac surgery with severe carotid stenosis.