Myocardial revascularisation in patients with carotid artery disease.

From January 1987 to December 1989, 80 patients with carotid bruit and/or history of transient ischaemic attack/stroke underwent digital subtraction angiography (DSA) prior to consideration for coronary artery bypass graft. Thirty-eight patients (Group I) out of the 80 had coronary artery bypass graft done with postoperative stroke in five (13.2%); this contrasted with a group of 320 patients (Group II) without cerebrovascular disease who underwent coronary artery bypass graft during the same period with postoperative stroke in two cases (0.63%) (p less than 0.0005). Carotid artery stenosis was noted on the DSA in 66% of Group I patients, with significant disease (greater than 70% occlusion) in 15%, while the study was normal in 34% of cases. Combined carotid endarterectomy and coronary artery bypass graft was done in five of Group I patients, with postoperative stroke in one; this was the only one among the stroke patients with significant carotid disease. All strokes, except in one patient, resolved within one to 6 1/2 months. These results suggest that the risk of stroke after coronary artery bypass graft is increased in patients with carotid bruit or history of transient ischaemic attack/stroke and in the presence of established carotid artery disease. The place of combined carotid endarterectomy and coronary artery bypass graft in these cases remains to be determined.