ABSTRACT
INTRODUCTION The role for carotid endarterectomy in stroke prevention due to significant extracranial carotid atherosclerosis is well-defined, in both the neurologically symptomatic and asymptomatic populations. Similarly, patients with significant coronary artery atherosclerosis, particularly those with critical stenoses in three coronary vessels and/or left main-stem disease, are known to benefit from coronary artery bypass grafting. It is not unusual, given common underlying risk factors and pathophysiological mechanisms, to find patients where significant carotid and coronary disease coexist. They are often identified when patients are assessed for treatment of one or the other. The importance of this is obvious when it is considered that surgery for carotid disease carries a risk of cardiac complications, and coronary artery bypass surgery can be complicated by perioperative ischemic stroke. The challenge for specialists involved in the treatment of the patient with significant disease in both vascular territories is to minimize the risk of the cardiac and neurological complications of carotid and coronary surgery.
