The risk of cerebrovascular accident in patients with asymptomatic critical carotid artery stenosis who undergo open-heart surgery.

OBJECTIVE To investigate whether the presence of asymptomatic critical carotid stenosis (ASCCS) increases the risk of perioperative stroke during open-heart surgery, which carries a well-established risk of cerebrovascular accidents. DESIGN A case series. SETTING A university-affiliated hospital that is a major referral centre for cardiovascular surgery. PATIENTS Forty-six patients with ASCCS who underwent open-heart surgery between January 1992 and January 1996. Of this group, 27 had bilateral and 19 had unilateral critical carotid artery stenosis. INTERVENTIONS Various cardiac procedures were performed on the 46 patients: 33 underwent coronary bypass grafting, 12 had valve replacement and 1 had heart transplantation. MAIN OUTCOME MEASURE Neurologic deficit. RESULTS None of the patients had any perioperative neurologic deficit up to the date of discharge. CONCLUSIONS Cardiac procedures, without prior carotid artery surgery, can be done in patients with ASCCS with no significant added risk of stroke. To achieve this, blood pressure should be kept stable intraoperatively, at slightly higher than normal pressure.