Combined carotid and coronary disease--a conservative strategy

The optimal approach to patients undergoing coronary bypass surgery for coronary artery disease with coexisting carotid disease is controversial. To determine the best approach to these patients, we screened carotid arteries in patients undergoing coronary artery bypass preoperatively with noninvasive ultrasonic duplex scanning. No correlation was noted between stroke and asymptomatic carotid disease in patients undergoing coronary revascularization. Prospective application of this finding in 2251 patients has yielded a very low incidence of perioperative stroke. We concluded that asymptomatic carotid arterial disease is not a significant risk to patients undergoing cardiopulmonary bypass and should be managed conservatively.