Concomitant carotid and coronary artery surgery in the prevention of postoperative stroke

OBJECTIVES: To review the use of simultaneous carotid and coronary surgery in the prevention of perioperative stroke. METHODS: The research was conducted between May and September 2012, through Medline. The selection was based on a review of the titles and abstracts. In addition, we performed a review of reference lists of each article. RESULTS: Perioperative stroke influences the patient's prognosis after coronary artery bypass surgery and is one of the most serious and deleterious consequences of this surgical procedure. Moreover, despite perioperative stroke etiology being multifactorial, carotid disease is frequently implicated. The management of patients with extracranial carotid and coronary disease is controversial and a solid approach remains unclear. Carotid revascularization can help reduce early or long term risk. CONCLUSION: The presence of an experienced surgical team, in a center with a large number of treated patients, is critical to a successful simultaneous surgery. This approach should be considered in symptomatic carotid stenosis and asymptomatic severe bilateral stenosis. In asymptomatic patients with severe carotid stenosis, the decision should be balanced with strict patient selection criteria.