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Controversies in Neurology
December 2008

Carotid Endarterectomy or Stenting Before Coronary Surgery?

Arch Neurol. 2008;65(12):1675. doi:10.1001/archneur.65.12.1675

Atherosclerosis typically affects multiple arteries in the same individual, so it is not surprising that many patients undergoing coronary artery bypass grafting (CABG) also have carotid atherosclerosis. The age-old dilemma has been which stenotic vessels should be corrected first in an individual who has significant atherosclerosis in the carotid as well as the coronary arteries. If CABG is performed in a patient with significant carotid stenosis, is that individual subjected to a greater risk of intraoperative stroke? Is it even safe to perform a carotid endarterectomy in an individual who has significant coronary artery disease? While no clinical trials have specifically addressed these questions, there is evidence that the stroke risk during CABG may have been overestimated.1

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