Asymptomatic carotid bruit in patients who undergo coronary artery surgery

The clinical significance of the presence of carotid bruit was evaluated in 643 patients who underwent coronary artery surgery alone or in combination with other cardiac procedures. Carotid bruit was heard in 31 patients (5%) who were neurologically asymptomatic. All of them underwent coronary artery surgery without additional carotid procedures, and none of them developed neurological deficits during the postoperative period. Of the remaining 612 patients, 18 were identified as having a history of focal neurological disorders, and 9 of them had carotid bruit. All were analyzed by means of noninvasive tests and angiography. Five underwent carotid endarterectomy prior to (2 patients) and simultaneously with (3 patients) a coronary bypass procedure. Seven patients developed neurological deficits postoperatively. Most of the deficits were not lateralized or focal but diffuse, which suggests global cerebral ischemia not related to carotid disease. Only 1 patient had proven carotid obstructive disease and underwent successful carotid thrombendarterectomy 10 days postoperatively. This study, although based on limited material, supports the hypothesis that patients with asymptomatic carotid bruit can safely undergo coronary artery surgery. In the group of patients without neurological symptomatology, postoperative neurological deficits were rarely caused by occlusive carotid disease. However, patients with asymptomatic carotid bruit should be closely followed with the goal of identifying those who are at risk of developing neurological deficits.