Measures to Prevent Neurologic Deficits in Urgent CABG Surgery With Bilateral Carotid Occlusion.

Patients with bilateral high-degree carotid stenosis or occlusion impose high risk for neurologic complications during coronary artery bypass graft surgery (CABG). Former articles have described successful CABG in patients with bilateral carotid artery occlusion with uneventful recovery, with perioperative cerebral blood flow monitoring consisting of electroencephalography or near-infrared spectroscopy. In this case report, we describe the use of pulsatile flow on cardiopulmonary bypass and transcranial Doppler monitoring during successful CABG in a patient with bilateral carotid occlusion, leading to a safe approach where changes in cerebral blood flow were seen and analyzed with no lag between event and monitoring.