Management of Carotid Artery Disease in the Setting of Coronary Artery Disease in Need of Coronary Artery Bypass Surgery

Coronary artery bypass graft surgery (CABG) is one of the most commonly performed major surgeries in the United States with over 397,000 CABG’s performed in 2010.(Go, Mozaffarian et al. 2012) One of the most dreadful adverse sequelae of CABG is stroke which is also the 2nd most common major post-operative complication seen with CABG, occurring in 1 to 5% of patients.(Furlan, Sila et al. 1992; Brown, Kugelmass et al. 2008) Patients suffering from postoperative stroke have a very high incidence of in-hospital mortality.(Hogue, Murphy et al. 1999) Studies have shown that presence of extracranial carotid artery stenosis (ECAS) is a strong risk factor for post-operative morbidity and mortality due post-CABG strokes.(Brown, Kugelmass et al. 2008) In this book chapter, we will review the epidemiology of concomitant coronary and carotid artery disease, the association with post-operative stroke, recommenda‐ tions for pre-operative ECAS screening and management options for patients in whom ECAS is identified.