Diseases of the aorta, pulmonary and peripheral vessels: Edited by Alan BravermanManagement of carotid disease in patients undergoing coronary artery bypass surgery is it time to change our approach?Venkatachalam, Sridhara; Shishehbor, Mehdi H.b Author Information aDepartment of Medicine bDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA Correspondence to Dr Mehdi H. Shishehbor, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J3-5 Cleveland, OH 44195, USA Tel: +1 216 636 6918; fax: +1 216 636 6957; e-mail: [email protected] Current Opinion in Cardiology 26(6):p 480-487, November 2011. | DOI: 10.1097/HCO.0b013e32834a7035 Buy Metrics Abstract Purpose of review The management of concurrent severe carotid and coronary disease is a subject of ongoing debate in the absence of randomized clinical trials. Amidst the growing controversy, the clinician has to carefully tailor the best strategy for a given patient based on neurologic and cardiac symptoms. This review aims to compile current evidence in this area to help plan strategies for the optimal management of coexisting severe carotid and coronary disease. Recent findings Carotid revascularization with carotid endarterectomy (CEA) or stenting (CAS) is frequently performed in conjunction with coronary artery bypass surgery (CABG) in the United States for asymptomatic carotid disease. The risk of perioperative stroke with unilateral asymptomatic 70–99% carotid stenosis is likely small based on several observational data. Moreover, the risk associated with both staged and combined CEA-CABG procedures in the asymptomatic population may outweigh any benefit. Carotid artery stenting is an alternative option in patients with severe coronary disease who are considered ‘high risk’ for CEA. Neurologically symptomatic patients require carotid revascularization prior to or in conjunction with CABG surgery. Ultimately, the choice of carotid revascularization or conservative management will depend on clinical characteristics, anatomy, and local expertise. Summary Severe carotid disease in the CABG population is often unilateral and asymptomatic. Based on the available data, conservative carotid therapy in the low-risk asymptomatic individuals is likely the best treatment option. Carotid revascularization may be justified in symptomatic or high-risk patients such as those with contralateral carotid occlusion or bilateral severe stenosis. © 2011 Lippincott Williams & Wilkins, Inc.