The presence of carotid occlusive disease (COD) in patients undergoing coronary artery bypass grafting (CABG) often raises concern about the risk of perioperative stroke. Although the role of COD as a risk factor for stroke is unquestioned, the role of COD alone, especially when asymptomatic, in predisposing patients to peri-CABG stroke is less certain, and the effectiveness of means to diminish it is controversial. Results from the Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Surgery Trial prompted some physicians to advocate carotid endarterectomy (CEA) for asymptomatic COD in patients undergoing CABG for stroke prevention.1,2Other physicians recommend medical treatment, citing concerns about the morbidity of CEA in this high-risk patient population, stating that the risk to benefit ratio does not warrant routine pre-CABG prophylactic CEA.
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