A Commentary on Concomitant Symptomatic Coronary Disease and Carotid Artery Stenosis -The Tufts Medical Center Experience

135 Despite the development of surgical outcomes, acute stroke remain a devastating complication following coronary artery bypass grafting (CABG) [1]. Coexistent CAD and carotid artery stenosis are prevalent due to their common background of systemic atherosclerosis (20%) [2]. Naylor, et al. [3,4] demonstrated that the risk of stroke associated with CABG is 3.2% in patients with asymptomatic, unilateral severe carotid stenosis, whereas these figures increase to 5.2% in those with bilateral carotid stenosis and 7% to 11.6% in those with carotid occlusion. The management of concomitant CAD and carotid artery disease has been elucidated over time. The combination of carotid endarterectomy (CEA) and CABG in the same surgical setting was introduced in the 1980s [5]. Nonetheless, the surgical management, particularly the timing and order of surgical procedures, remains varied across North America. This commentary reflects upon the Tufts Medical Center experience on the current knowledge of the prevention of perioperative stroke in patients with concurrent CAD and carotid artery disease, focusing on simultaneous CEA/CABG.