Risk of stroke during coronary artery bypass graft surgery in patients with internal carotid artery disease documented by angiography.

We retrospectively identified 144 patients who underwent coronary artery bypass graft (CABG) surgery in the presence of angiographically documented greater than or equal to 50% internal carotid stenosis or occlusion. Of these, 115 patients had bilateral carotid lesions and received combined operations involving carotid endarterectomy on only one side. The remaining 29 patients, including 11 with bilateral carotid lesions, underwent coronary bypass alone. Nine cerebral infarcts occurred (6%), but only three strokes (2%) were appropriate to the cerebral hemisphere ipsilateral to unoperated carotid stenosis. There was one stroke (3%) among the 29 patients who did not undergo combined procedures. In the group of 115 patients with bilateral carotid disease who received unilateral combined carotid endarterectomy there were 8 perioperative strokes (7%), of which 6 were ipsilateral to the endarterectomy. Asymptomatic unilateral less than 90% ICA stenosis or ICA occlusion does not increase stroke risk during CABG surgery.